- 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
- $434.97 / $469.82 / $946.43
| Professional | | $434.97 | $469.82 | $946.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $572.12 / $723.40 / $868.08
| Professional | | $572.12 | $723.40 | $868.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $775.42 / $871.21 / $2,077.00
| Professional | | $775.42 | $871.21 | $2,077.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $636.59 / $694.46 / $810.21
| Professional | | $636.59 | $694.46 | $810.21 |
- 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
- $557.91 / $722.56 / $859.26
| Professional | | $557.91 | $722.56 | $859.26 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $613.37 / $2,575.00 / $6,124.00
| Professional | | $613.37 | $2,575.00 | $6,124.00 |