- 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
- $419.06 / $439.11 / $439.11
| Professional | | $419.06 | $439.11 | $439.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $406.64 / $546.23 / $546.23
| Professional | | $406.64 | $546.23 | $546.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.77 / $671.68 / $6,874.20
| Professional | | $583.77 | $671.68 | $6,874.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $480.68 / $524.38 / $611.77
| Professional | | $480.68 | $524.38 | $611.77 |
- 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
- $445.72 / $546.23 / $689.31
| Professional | | $445.72 | $546.23 | $689.31 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.02 / $2,582.96 / $6,124.00
| Professional | | $535.02 | $2,582.96 | $6,124.00 |