- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,324.03 / $2,747.00 / $4,456.00
| Facility | | $1,324.03 | $2,747.00 | $4,456.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.00 / $682.76 / $2,478.00
| Professional | | $49.00 | $682.76 | $2,478.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,011.80 / $9,552.00 / $13,377.00
| Professional | | $8,011.80 | $9,552.00 | $13,377.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.00 / $200.00 / $200.00
| Professional | | $200.00 | $200.00 | $200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $2,155.00 / $2,155.00
| Facility | | $2,155.00 | $2,155.00 | $2,155.00 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,279.00 / $3,709.33 / $6,172.00
| Professional | | $1,279.00 | $3,709.33 | $6,172.00 |