- 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
- $246.11 / $261.45 / $261.45
| Professional | | $246.11 | $261.45 | $261.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.24 / $290.43 / $298.16
| Professional | | $237.24 | $290.43 | $298.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.87 / $403.71 / $4,334.00
| Professional | | $350.87 | $403.71 | $4,334.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.57 / $278.81 / $325.27
| Professional | | $255.57 | $278.81 | $325.27 |
- 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
- $236.99 / $291.35 / $379.70
| Professional | | $236.99 | $291.35 | $379.70 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.23 / $3,191.04 / $8,000.00
| Professional | | $279.23 | $3,191.04 | $8,000.00 |