- 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
- $386.68 / $416.89 / $649.69
| Professional | | $386.68 | $416.89 | $649.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.96 / $516.75 / $516.75
| Professional | | $402.96 | $516.75 | $516.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $591.83 / $680.95 / $6,874.20
| Professional | | $591.83 | $680.95 | $6,874.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $454.74 / $496.08 / $578.76
| Professional | | $454.74 | $496.08 | $578.76 |
- 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
- $421.67 / $516.75 / $657.15
| Professional | | $421.67 | $516.75 | $657.15 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.82 / $2,582.96 / $6,124.00
| Professional | | $491.82 | $2,582.96 | $6,124.00 |