- 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
- $483.61 / $569.79 / $929.88
| Professional | | $483.61 | $569.79 | $929.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.05 / $730.08 / $876.09
| Professional | | $561.05 | $730.08 | $876.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $754.57 / $847.78 / $5,851.00
| Professional | | $754.57 | $847.78 | $5,851.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $642.47 / $700.87 / $817.68
| Professional | | $642.47 | $700.87 | $817.68 |
- 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
- $590.04 / $730.08 / $907.25
| Professional | | $590.04 | $730.08 | $907.25 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $681.00 / $2,582.96 / $6,124.00
| Professional | | $681.00 | $2,582.96 | $6,124.00 |