- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,635.55 / $2,747.00 / $5,484.00
| Facility | | $1,635.55 | $2,747.00 | $5,484.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.36 / $398.84 / $628.90
| Professional | | $342.36 | $398.84 | $628.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,537.42 / $1,537.42 / $1,537.42
| Facility | | $1,537.42 | $1,537.42 | $1,537.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.00 / $504.88 / $1,008.67
| Professional | | $385.00 | $504.88 | $1,008.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.01 / $601.10 / $723.83
| Professional | | $535.01 | $601.10 | $723.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.29 / $484.68 / $565.46
| Professional | | $444.29 | $484.68 | $565.46 |
- 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
- $368.59 / $515.13 / $679.97
| Professional | | $368.59 | $515.13 | $679.97 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.96 / $3,900.00 / $8,000.00
| Professional | | $513.96 | $3,900.00 | $8,000.00 |