- 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
- $376.26 / $400.17 / $695.89
| Professional | | $376.26 | $400.17 | $695.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415.39 / $547.60 / $657.12
| Professional | | $415.39 | $547.60 | $657.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.60 / $636.49 / $786.86
| Professional | | $581.60 | $636.49 | $786.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $481.89 / $525.70 / $613.30
| Professional | | $481.89 | $525.70 | $613.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $2,155.00 / $2,155.00
| Facility | | $2,155.00 | $2,155.00 | $2,155.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.84 / $547.60 / $688.50
| Professional | | $446.84 | $547.60 | $688.50 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $511.86 / $2,575.00 / $6,124.00
| Professional | | $511.86 | $2,575.00 | $6,124.00 |