- 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
- $549.00 / $626.82 / $992.18
| Professional | | $549.00 | $626.82 | $992.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.12 / $779.11 / $934.94
| Professional | | $600.12 | $779.11 | $934.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $805.17 / $904.63 / $3,857.00
| Professional | | $805.17 | $904.63 | $3,857.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $685.62 / $747.95 / $872.61
| Professional | | $685.62 | $747.95 | $872.61 |
- 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
- $605.40 / $779.11 / $971.69
| Professional | | $605.40 | $779.11 | $971.69 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $713.22 / $3,191.04 / $8,000.00
| Professional | | $713.22 | $3,191.04 | $8,000.00 |