- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,528.00 / $6,084.00 / $10,759.24
| Facility | | $2,528.00 | $6,084.00 | $10,759.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.85 / $539.73 / $9,122.20
| Professional | | $57.85 | $539.73 | $9,122.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,005.68 / $7,359.90 / $8,831.87
| Professional | | $6,005.68 | $7,359.90 | $8,831.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $751.90 / $889.12 / $9,792.98
| Professional | | $751.90 | $889.12 | $9,792.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $509.47 / $6,241.20 / $7,359.90
| Professional | | $509.47 | $6,241.20 | $7,359.90 |
- 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
- $6,005.68 / $7,359.90 / $11,566.80
| Professional | | $6,005.68 | $7,359.90 | $11,566.80 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $625.87 / $7,208.00 / $9,764.00
| Professional | | $625.87 | $7,208.00 | $9,764.00 |