- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,861.43 / $2,747.00 / $6,749.00
| Facility | | $1,861.43 | $2,747.00 | $6,749.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.95 / $296.10 / $1,074.00
| Professional | | $176.95 | $296.10 | $1,074.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.07 / $257.49 / $309.36
| Professional | | $217.07 | $257.49 | $309.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.55 / $333.90 / $3,935.00
| Professional | | $74.55 | $333.90 | $3,935.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.13 / $296.99 / $346.49
| Professional | | $239.13 | $296.99 | $346.49 |
- 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
- $252.44 / $309.36 / $378.38
| Professional | | $252.44 | $309.36 | $378.38 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.64 / $3,502.00 / $9,057.00
| Professional | | $267.64 | $3,502.00 | $9,057.00 |