- 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
- $481.19 / $584.46 / $933.59
| Professional | | $481.19 | $584.46 | $933.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $567.21 / $733.80 / $880.56
| Professional | | $567.21 | $733.80 | $880.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $762.31 / $856.47 / $5,851.00
| Professional | | $762.31 | $856.47 | $5,851.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.74 / $704.45 / $821.86
| Professional | | $645.74 | $704.45 | $821.86 |
- 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
- $570.95 / $733.80 / $915.83
| Professional | | $570.95 | $733.80 | $915.83 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.60 / $2,575.00 / $6,124.00
| Professional | | $583.60 | $2,575.00 | $6,124.00 |