- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,924.00 / $5,484.00 / $5,484.00
| Facility | | $1,924.00 | $5,484.00 | $5,484.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $557.00 / $697.65 / $2,295.21
| Professional | | $557.00 | $697.65 | $2,295.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $538.34 / $697.65 / $837.18
| Professional | | $538.34 | $697.65 | $837.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $790.53 / $888.19 / $5,851.00
| Professional | | $790.53 | $888.19 | $5,851.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $613.92 / $669.74 / $781.37
| Professional | | $613.92 | $669.74 | $781.37 |
- 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
- $569.28 / $697.65 / $876.78
| Professional | | $569.28 | $697.65 | $876.78 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $666.35 / $3,900.00 / $8,000.00
| Professional | | $666.35 | $3,900.00 | $8,000.00 |