- 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
- $302.27 / $355.77 / $415.62
| Professional | | $302.27 | $355.77 | $415.62 |
- 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
- $338.54 / $454.66 / $719.28
| Professional | | $338.54 | $454.66 | $719.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.54 / $570.23 / $686.67
| Professional | | $507.54 | $570.23 | $686.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.58 / $372.64 / $434.74
| Professional | | $341.58 | $372.64 | $434.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $2,155.00 / $2,155.00
| Facility | | $2,155.00 | $2,155.00 | $2,155.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.74 / $423.42 / $533.30
| Professional | | $316.74 | $423.42 | $533.30 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $419.77 / $2,582.96 / $6,124.00
| Professional | | $419.77 | $2,582.96 | $6,124.00 |