- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,747.00 / $6,966.00 / $8,499.00
| Facility | | $2,747.00 | $6,966.00 | $8,499.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.17 / $434.92 / $677.95
| Professional | | $434.17 | $434.92 | $677.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.48 / $540.59 / $540.59
| Professional | | $425.48 | $540.59 | $540.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $604.41 / $695.43 / $6,874.20
| Professional | | $604.41 | $695.43 | $6,874.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $475.72 / $518.96 / $605.46
| Professional | | $475.72 | $518.96 | $605.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $3,028.00 / $3,028.00
| Facility | | $3,028.00 | $3,028.00 | $3,028.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.12 / $540.59 / $690.09
| Professional | | $441.12 | $540.59 | $690.09 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.83 / $9,435.00 / $12,953.00
| Professional | | $383.83 | $9,435.00 | $12,953.00 |