- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,924.00 / $5,484.00 / $6,718.00
| Facility | | $1,924.00 | $5,484.00 | $6,718.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.99 / $543.82 / $543.82
| Professional | | $535.99 | $543.82 | $543.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.03 / $700.44 / $700.44
| Professional | | $520.03 | $700.44 | $700.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $736.19 / $847.06 / $8,902.00
| Professional | | $736.19 | $847.06 | $8,902.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.39 / $672.42 / $784.49
| Professional | | $616.39 | $672.42 | $784.49 |
- 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
- $571.55 / $700.44 / $876.89
| Professional | | $571.55 | $700.44 | $876.89 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $503.09 / $820.33
| Professional | | $29.27 | $503.09 | $820.33 |