- 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
- $629.08 / $629.08 / $629.08
| Professional | | $629.08 | $629.08 | $629.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $664.15 / $664.15 / $797.01
| Professional | | $664.15 | $664.15 | $797.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $878.04 / $1,136.63 / $11,429.00
| Professional | | $878.04 | $1,136.63 | $11,429.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $584.45 / $637.58 / $743.85
| Professional | | $584.45 | $637.58 | $743.85 |
- 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
- $541.95 / $742.33 / $971.37
| Professional | | $541.95 | $742.33 | $971.37 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $732.64 / $2,582.96 / $6,124.00
| Professional | | $732.64 | $2,582.96 | $6,124.00 |