- 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
- $558.21 / $558.21 / $558.21
| Professional | | $558.21 | $558.21 | $558.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.91 / $681.38 / $817.65
| Professional | | $520.91 | $681.38 | $817.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $714.63 / $802.91 / $3,857.00
| Professional | | $714.63 | $802.91 | $3,857.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $599.61 / $654.12 / $763.14
| Professional | | $599.61 | $654.12 | $763.14 |
- 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
- $554.72 / $681.38 / $882.26
| Professional | | $554.72 | $681.38 | $882.26 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $580.41 / $2,575.00 / $6,124.00
| Professional | | $580.41 | $2,575.00 | $6,124.00 |