- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,583.13 / $3,107.00 / $8,431.00
| Facility | | $2,583.13 | $3,107.00 | $8,431.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.41 / $457.41 / $457.41
| Professional | | $457.41 | $457.41 | $457.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.27 / $595.34 / $714.41
| Professional | | $458.27 | $595.34 | $714.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $615.54 / $691.59 / $5,851.00
| Professional | | $615.54 | $691.59 | $5,851.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $523.90 / $571.52 / $666.78
| Professional | | $523.90 | $571.52 | $666.78 |
- 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 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.45 / $595.34 / $741.41
| Professional | | $461.45 | $595.34 | $741.41 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.96 / $5,212.49 / $11,157.30
| Professional | | $513.96 | $5,212.49 | $11,157.30 |