- 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
- $414.94 / $453.97 / $453.97
| Professional | | $414.94 | $453.97 | $453.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.40 / $655.84 / $655.84
| Professional | | $507.40 | $655.84 | $655.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $693.02 / $797.38 / $4,334.00
| Professional | | $693.02 | $797.38 | $4,334.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $577.14 / $629.60 / $734.54
| Professional | | $577.14 | $629.60 | $734.54 |
- 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
- $535.16 / $655.84 / $823.70
| Professional | | $535.16 | $655.84 | $823.70 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.59 / $2,650.00 / $6,124.00
| Professional | | $707.59 | $2,650.00 | $6,124.00 |