- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,747.00 / $6,966.00 / $8,499.00
| Facility | | $2,747.00 | $6,966.00 | $8,499.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $773.54 / $864.45 / $7,822.16
| Professional | | $773.54 | $864.45 | $7,822.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,019.51 / $7,426.66 / $7,453.06
| Professional | | $1,019.51 | $7,426.66 | $7,453.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,699.80 / $2,010.01 / $2,566.41
| Professional | | $1,699.80 | $2,010.01 | $2,566.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $834.30 / $6,558.70 / $8,347.43
| Professional | | $834.30 | $6,558.70 | $8,347.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,340.00 / $3,340.00 / $3,340.00
| Facility | | $3,340.00 | $3,340.00 | $3,340.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,081.70 / $7,453.06 / $10,726.71
| Professional | | $6,081.70 | $7,453.06 | $10,726.71 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,018.38 / $8,897.96 / $12,905.00
| Professional | | $1,018.38 | $8,897.96 | $12,905.00 |