- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $864.50 / $2,747.00 / $2,898.00
| Facility | | $864.50 | $2,747.00 | $2,898.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.19 / $360.91 / $1,287.63
| Professional | | $298.19 | $360.91 | $1,287.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.84 / $475.14 / $570.16
| Professional | | $360.84 | $475.14 | $570.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.91 / $538.07 / $3,857.00
| Professional | | $478.91 | $538.07 | $3,857.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $418.12 / $456.13 / $532.15
| Professional | | $418.12 | $456.13 | $532.15 |
- 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
- $343.05 / $475.14 / $581.96
| Professional | | $343.05 | $475.14 | $581.96 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.37 / $1,500.00 / $3,725.00
| Professional | | $335.37 | $1,500.00 | $3,725.00 |