- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,324.03 / $2,747.00 / $4,456.00
| Facility | | $1,324.03 | $2,747.00 | $4,456.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $615.20 / $615.20 / $615.20
| Professional | | $615.20 | $615.20 | $615.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $591.57 / $766.71 / $920.06
| Professional | | $591.57 | $766.71 | $920.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $801.98 / $877.69 / $1,036.21
| Professional | | $801.98 | $877.69 | $1,036.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $674.71 / $736.04 / $858.72
| Professional | | $674.71 | $736.04 | $858.72 |
- 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
- $625.64 / $766.71 / $959.94
| Professional | | $625.64 | $766.71 | $959.94 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $694.98 / $2,575.00 / $6,124.00
| Professional | | $694.98 | $2,575.00 | $6,124.00 |