- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,747.00 / $8,431.00 / $10,303.00
| Facility | | $2,747.00 | $8,431.00 | $10,303.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.76 / $723.39 / $8,327.00
| Professional | | $456.76 | $723.39 | $8,327.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $587.20 / $6,945.94 / $7,416.68
| Professional | | $587.20 | $6,945.94 | $7,416.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $774.65 / $959.19 / $9,367.77
| Professional | | $774.65 | $959.19 | $9,367.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $570.48 / $6,112.43 / $6,945.94
| Professional | | $570.48 | $6,112.43 | $6,945.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,252.00 / $4,252.00 / $4,252.00
| Facility | | $4,252.00 | $4,252.00 | $4,252.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,667.89 / $7,750.83 / $11,134.97
| Professional | | $5,667.89 | $7,750.83 | $11,134.97 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.94 / $682.16 / $6,487.00
| Professional | | $85.94 | $682.16 | $6,487.00 |