- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,747.00 / $5,484.00 / $6,637.71
| Facility | | $2,747.00 | $5,484.00 | $6,637.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.88 / $455.97 / $1,660.49
| Professional | | $400.88 | $455.97 | $1,660.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.69 / $501.10 / $501.10
| Professional | | $410.69 | $501.10 | $501.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $577.29 / $664.22 / $8,902.00
| Professional | | $577.29 | $664.22 | $8,902.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.97 / $481.06 / $561.23
| Professional | | $440.97 | $481.06 | $561.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $2,912.00 / $2,912.00
| Facility | | $2,912.00 | $2,912.00 | $2,912.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.10 / $538.30 / $657.80
| Professional | | $501.10 | $538.30 | $657.80 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $499.92 / $6,612.00 / $9,416.00
| Professional | | $499.92 | $6,612.00 | $9,416.00 |