- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,528.00 / $6,084.00 / $7,424.00
| Facility | | $2,528.00 | $6,084.00 | $7,424.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $917.63 / $951.62 / $951.62
| Professional | | $917.63 | $951.62 | $951.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $883.42 / $1,098.49 / $1,098.49
| Professional | | $883.42 | $1,098.49 | $1,098.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,252.80 / $1,441.45 / $8,902.00
| Professional | | $1,252.80 | $1,441.45 | $8,902.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $966.67 / $1,054.55 / $1,230.31
| Professional | | $966.67 | $1,054.55 | $1,230.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,446.00 / $2,446.00 / $2,446.00
| Facility | | $2,446.00 | $2,446.00 | $2,446.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,088.14 / $1,155.88 / $1,424.49
| Professional | | $1,088.14 | $1,155.88 | $1,424.49 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $908.91 / $1,430.40
| Professional | | $29.27 | $908.91 | $1,430.40 |