- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,861.43 / $2,747.00 / $6,084.00
| Facility | | $1,861.43 | $2,747.00 | $6,084.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $419.80 / $564.90 / $927.58
| Professional | | $419.80 | $564.90 | $927.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.77 / $712.95 / $855.54
| Professional | | $581.77 | $712.95 | $855.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $614.45 / $715.86 / $872.52
| Professional | | $614.45 | $715.86 | $872.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.19 / $585.69 / $712.95
| Professional | | $460.19 | $585.69 | $712.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,689.00 / $1,689.00 / $1,689.00
| Facility | | $1,689.00 | $1,689.00 | $1,689.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $577.44 / $712.95 / $1,278.33
| Professional | | $577.44 | $712.95 | $1,278.33 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.33 / $3,619.79 / $9,324.00
| Professional | | $448.33 | $3,619.79 | $9,324.00 |