- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,324.03 / $2,747.00 / $4,456.00
| Facility | | $1,324.03 | $2,747.00 | $4,456.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.19 / $572.90 / $731.26
| Professional | | $506.19 | $572.90 | $731.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,244.58 / $1,244.58 / $1,244.58
| Facility | | $1,244.58 | $1,244.58 | $1,244.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $569.47 / $770.08 / $1,527.63
| Professional | | $569.47 | $770.08 | $1,527.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $821.28 / $922.73 / $1,061.14
| Professional | | $821.28 | $922.73 | $1,061.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $670.00 / $739.27 / $862.48
| Professional | | $670.00 | $739.27 | $862.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $1,981.00 / $1,981.00
| Facility | | $1,981.00 | $1,981.00 | $1,981.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.98 / $770.08 / $1,027.64
| Professional | | $583.98 | $770.08 | $1,027.64 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.23 / $2,575.00 / $6,124.00
| Professional | | $561.23 | $2,575.00 | $6,124.00 |