- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,486.00 / $3,883.00 / $4,705.00
| Facility | | $1,486.00 | $3,883.00 | $4,705.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.60 / $436.41 / $436.41
| Professional | | $351.60 | $436.41 | $436.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $433.44 / $564.79 / $564.79
| Professional | | $433.44 | $564.79 | $564.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.06 / $638.96 / $4,334.00
| Professional | | $72.06 | $638.96 | $4,334.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $497.01 / $542.20 / $632.55
| Professional | | $497.01 | $542.20 | $632.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,446.00 / $2,446.00 / $2,446.00
| Facility | | $2,446.00 | $2,446.00 | $2,446.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.87 / $564.79 / $714.30
| Professional | | $460.87 | $564.79 | $714.30 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $414.39 / $733.23
| Professional | | $29.27 | $414.39 | $733.23 |