- 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
- $566.63 / $566.63 / $566.63
| Professional | | $566.63 | $566.63 | $566.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $568.52 / $737.55 / $885.06
| Professional | | $568.52 | $737.55 | $885.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $763.90 / $836.00 / $987.00
| Professional | | $763.90 | $836.00 | $987.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $649.04 / $708.05 / $826.06
| Professional | | $649.04 | $708.05 | $826.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $1,981.00 / $1,981.00
| Facility | | $1,981.00 | $1,981.00 | $1,981.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $573.00 / $737.55 / $919.04
| Professional | | $573.00 | $737.55 | $919.04 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $669.85 / $2,582.96 / $6,124.00
| Professional | | $669.85 | $2,582.96 | $6,124.00 |