- 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
- $436.59 / $440.26 / $440.26
| Professional | | $436.59 | $440.26 | $440.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.76 / $541.58 / $541.58
| Professional | | $427.76 | $541.58 | $541.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $617.89 / $710.94 / $8,902.00
| Professional | | $617.89 | $710.94 | $8,902.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.59 / $519.91 / $606.55
| Professional | | $476.59 | $519.91 | $606.55 |
- 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
- $441.93 / $541.58 / $692.64
| Professional | | $441.93 | $541.58 | $692.64 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.17 / $3,900.00 / $8,000.00
| Professional | | $516.17 | $3,900.00 | $8,000.00 |