- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,747.00 / $3,847.00 / $11,346.00
| Facility | | $2,747.00 | $3,847.00 | $11,346.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $970.81 / $1,073.01 / $1,073.01
| Professional | | $970.81 | $1,073.01 | $1,073.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $710.14 / $710.14 / $1,351.23
| Professional | | $710.14 | $710.14 | $1,351.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,457.90 / $1,677.45 / $11,782.00
| Professional | | $1,457.90 | $1,677.45 | $11,782.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $624.91 / $681.73 / $795.35
| Professional | | $624.91 | $681.73 | $795.35 |
- 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
- $579.47 / $1,334.72 / $1,785.50
| Professional | | $579.47 | $1,334.72 | $1,785.50 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $805.55 / $9,435.00 / $12,953.00
| Professional | | $805.55 | $9,435.00 | $12,953.00 |