- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,635.55 / $2,747.00 / $5,484.00
| Facility | | $1,635.55 | $2,747.00 | $5,484.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.73 / $329.91 / $544.71
| Professional | | $286.73 | $329.91 | $544.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.64 / $422.71 / $507.26
| Professional | | $323.64 | $422.71 | $507.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $431.66 / $484.99 / $2,077.00
| Professional | | $431.66 | $484.99 | $2,077.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.99 / $405.80 / $473.44
| Professional | | $371.99 | $405.80 | $473.44 |
- 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
- $317.82 / $422.71 / $515.28
| Professional | | $317.82 | $422.71 | $515.28 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $395.63 / $3,191.04 / $8,000.00
| Professional | | $395.63 | $3,191.04 | $8,000.00 |