- 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
- $552.29 / $552.30 / $971.04
| Professional | | $552.29 | $552.30 | $971.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.61 / $768.76 / $768.76
| Professional | | $561.61 | $768.76 | $768.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $822.35 / $946.19 / $8,902.00
| Professional | | $822.35 | $946.19 | $8,902.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.51 / $738.01 / $861.01
| Professional | | $676.51 | $738.01 | $861.01 |
- 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
- $627.30 / $768.76 / $951.32
| Professional | | $627.30 | $768.76 | $951.32 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.96 / $2,582.96 / $6,124.00
| Professional | | $561.96 | $2,582.96 | $6,124.00 |