- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.00 / $2,898.00 / $3,444.00
| Facility | | $988.00 | $2,898.00 | $3,444.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.41 / $534.41 / $544.12
| Professional | | $534.41 | $534.41 | $544.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.28 / $658.15 / $658.15
| Professional | | $529.28 | $658.15 | $658.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $739.30 / $830.62 / $980.13
| Professional | | $739.30 | $830.62 | $980.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.16 / $631.82 / $737.13
| Professional | | $579.16 | $631.82 | $737.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $1,106.00 / $1,106.00
| Facility | | $1,106.00 | $1,106.00 | $1,106.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.04 / $658.15 / $840.77
| Professional | | $537.04 | $658.15 | $840.77 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $467.84 / $830.38
| Professional | | $29.27 | $467.84 | $830.38 |