- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,747.00 / $8,431.00 / $10,303.00
| Facility | | $2,747.00 | $8,431.00 | $10,303.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.03 / $461.03 / $461.03
| Professional | | $461.03 | $461.03 | $461.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.44 / $428.44 / $581.67
| Professional | | $428.44 | $428.44 | $581.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $696.38 / $883.36 / $7,402.00
| Professional | | $696.38 | $883.36 | $7,402.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.03 / $411.30 / $479.85
| Professional | | $377.03 | $411.30 | $479.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,425.00 / $7,425.00 / $7,425.00
| Facility | | $7,425.00 | $7,425.00 | $7,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.61 / $438.14 / $592.72
| Professional | | $349.61 | $438.14 | $592.72 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $474.23 / $817.10
| Professional | | $29.27 | $474.23 | $817.10 |