- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,747.00 / $8,210.00 / $10,007.00
| Facility | | $2,747.00 | $8,210.00 | $10,007.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.30 / $651.65 / $2,582.00
| Professional | | $313.30 | $651.65 | $2,582.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $675.26 / $720.64 / $979.18
| Professional | | $675.26 | $720.64 | $979.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $929.74 / $1,059.92 / $17,536.00
| Professional | | $929.74 | $1,059.92 | $17,536.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $594.23 / $648.25 / $756.29
| Professional | | $594.23 | $648.25 | $756.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $3,028.00 / $3,028.00
| Facility | | $3,028.00 | $3,028.00 | $3,028.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $551.01 / $706.30 / $914.37
| Professional | | $551.01 | $706.30 | $914.37 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.20 / $10,610.00 / $12,953.00
| Professional | | $600.20 | $10,610.00 | $12,953.00 |