- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $864.50 / $2,747.00 / $2,898.00
| Facility | | $864.50 | $2,747.00 | $2,898.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $624.41 / $624.41 / $624.41
| Professional | | $624.41 | $624.41 | $624.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $622.04 / $719.95 / $863.94
| Professional | | $622.04 | $719.95 | $863.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $754.97 / $848.23 / $7,637.00
| Professional | | $754.97 | $848.23 | $7,637.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $633.55 / $691.15 / $806.34
| Professional | | $633.55 | $691.15 | $806.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $1,981.00 / $1,981.00
| Facility | | $1,981.00 | $1,981.00 | $1,981.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.64 / $691.96 / $725.18
| Professional | | $507.64 | $691.96 | $725.18 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.91 / $1,500.00 / $3,725.00
| Professional | | $515.91 | $1,500.00 | $3,725.00 |