- 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
- $552.66 / $552.66 / $552.66
| Professional | | $552.66 | $552.66 | $552.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.49 / $745.93 / $895.11
| Professional | | $575.49 | $745.93 | $895.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $775.12 / $820.72 / $943.83
| Professional | | $775.12 | $820.72 | $943.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $656.41 / $716.09 / $835.44
| Professional | | $656.41 | $716.09 | $835.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $1,981.00 / $1,981.00
| Facility | | $1,981.00 | $1,981.00 | $1,981.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $587.16 / $745.93 / $939.03
| Professional | | $587.16 | $745.93 | $939.03 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.46 / $2,575.00 / $6,124.00
| Professional | | $562.46 | $2,575.00 | $6,124.00 |