- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,861.43 / $2,747.00 / $6,084.00
| Facility | | $1,861.43 | $2,747.00 | $6,084.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.36 / $478.16 / $823.32
| Professional | | $383.36 | $478.16 | $823.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $470.28 / $665.26 / $665.26
| Professional | | $470.28 | $665.26 | $665.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $657.53 / $756.55 / $4,334.00
| Professional | | $657.53 | $756.55 | $4,334.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $585.42 / $638.65 / $745.09
| Professional | | $585.42 | $638.65 | $745.09 |
- 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
- $542.85 / $665.26 / $812.91
| Professional | | $542.85 | $665.26 | $812.91 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $654.74 / $3,692.19 / $9,324.00
| Professional | | $654.74 | $3,692.19 | $9,324.00 |