- 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
- $441.14 / $470.56 / $861.26
| Professional | | $441.14 | $470.56 | $861.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $518.78 / $674.98 / $809.97
| Professional | | $518.78 | $674.98 | $809.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $695.17 / $781.05 / $3,857.00
| Professional | | $695.17 | $781.05 | $3,857.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.98 / $647.98 / $755.97
| Professional | | $593.98 | $647.98 | $755.97 |
- 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
- $520.69 / $674.98 / $837.03
| Professional | | $520.69 | $674.98 | $837.03 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.67 / $2,575.00 / $6,124.00
| Professional | | $540.67 | $2,575.00 | $6,124.00 |