- 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
- $573.04 / $573.04 / $575.25
| Professional | | $573.04 | $573.04 | $575.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $558.84 / $729.51 / $729.51
| Professional | | $558.84 | $729.51 | $729.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $779.55 / $875.85 / $1,033.50
| Professional | | $779.55 | $875.85 | $1,033.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $641.97 / $700.33 / $817.05
| Professional | | $641.97 | $700.33 | $817.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $2,912.00 / $2,912.00
| Facility | | $2,912.00 | $2,912.00 | $2,912.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $595.28 / $729.51 / $931.59
| Professional | | $595.28 | $729.51 | $931.59 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $714.46 / $3,692.19 / $9,324.00
| Professional | | $714.46 | $3,692.19 | $9,324.00 |