- 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
- $516.96 / $516.96 / $552.01
| Professional | | $516.96 | $516.96 | $552.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.24 / $685.43 / $685.43
| Professional | | $549.24 | $685.43 | $685.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $727.60 / $837.17 / $4,334.00
| Professional | | $727.60 | $837.17 | $4,334.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $603.16 / $658.01 / $767.68
| Professional | | $603.16 | $658.01 | $767.68 |
- 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
- $559.30 / $685.43 / $878.45
| Professional | | $559.30 | $685.43 | $878.45 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.96 / $3,692.19 / $9,324.00
| Professional | | $513.96 | $3,692.19 | $9,324.00 |