- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,635.55 / $2,747.00 / $5,484.00
| Facility | | $1,635.55 | $2,747.00 | $5,484.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.18 / $395.10 / $709.73
| Professional | | $263.18 | $395.10 | $709.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.09 / $546.83 / $656.19
| Professional | | $430.09 | $546.83 | $656.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $445.52 / $526.83 / $677.15
| Professional | | $445.52 | $526.83 | $677.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.08 / $463.71 / $546.83
| Professional | | $318.08 | $463.71 | $546.83 |
- 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
- $438.84 / $546.83 / $717.18
| Professional | | $438.84 | $546.83 | $717.18 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.33 / $3,098.10 / $8,000.00
| Professional | | $393.33 | $3,098.10 | $8,000.00 |