- 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
- $394.98 / $506.48 / $506.48
| Professional | | $394.98 | $506.48 | $506.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $473.56 / $615.40 / $738.48
| Professional | | $473.56 | $615.40 | $738.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $635.40 / $713.89 / $8,430.00
| Professional | | $635.40 | $713.89 | $8,430.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.54 / $590.78 / $689.25
| Professional | | $541.54 | $590.78 | $689.25 |
- 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
- $470.87 / $615.40 / $758.67
| Professional | | $470.87 | $615.40 | $758.67 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.96 / $2,575.00 / $6,124.00
| Professional | | $513.96 | $2,575.00 | $6,124.00 |