- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,861.43 / $2,747.00 / $6,084.00
| Facility | | $1,861.43 | $2,747.00 | $6,084.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.43 / $469.43 / $772.26
| Professional | | $469.43 | $469.43 | $772.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $466.37 / $606.25 / $727.50
| Professional | | $466.37 | $606.25 | $727.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $626.11 / $703.45 / $5,851.00
| Professional | | $626.11 | $703.45 | $5,851.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $533.50 / $582.00 / $679.00
| Professional | | $533.50 | $582.00 | $679.00 |
- 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
- $469.87 / $606.25 / $754.61
| Professional | | $469.87 | $606.25 | $754.61 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.96 / $3,619.79 / $9,324.00
| Professional | | $513.96 | $3,619.79 | $9,324.00 |