- 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
- $566.54 / $566.54 / $566.54
| Professional | | $566.54 | $566.54 | $566.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $555.33 / $642.74 / $771.29
| Professional | | $555.33 | $642.74 | $771.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $668.07 / $785.96 / $885.70
| Professional | | $668.07 | $785.96 | $885.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $565.61 / $617.03 / $719.87
| Professional | | $565.61 | $617.03 | $719.87 |
- 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
- $475.72 / $623.30 / $821.88
| Professional | | $475.72 | $623.30 | $821.88 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.96 / $3,520.00 / $9,057.00
| Professional | | $513.96 | $3,520.00 | $9,057.00 |