- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,528.00 / $6,084.00 / $7,424.00
| Facility | | $2,528.00 | $6,084.00 | $7,424.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $604.84 / $632.09 / $632.09
| Professional | | $604.84 | $632.09 | $632.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.22 / $726.10 / $726.10
| Professional | | $581.22 | $726.10 | $726.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $822.45 / $946.30 / $8,902.00
| Professional | | $822.45 | $946.30 | $8,902.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.97 / $697.06 / $813.23
| Professional | | $638.97 | $697.06 | $813.23 |
- 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
- $592.50 / $726.10 / $933.20
| Professional | | $592.50 | $726.10 | $933.20 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $518.03 / $780.10
| Professional | | $29.27 | $518.03 | $780.10 |