- 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
- $519.04 / $519.04 / $672.33
| Professional | | $519.04 | $519.04 | $672.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $657.42 / $760.90 / $913.08
| Professional | | $657.42 | $760.90 | $913.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $695.63 / $818.39 / $4,284.89
| Professional | | $695.63 | $818.39 | $4,284.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.65 / $669.59 / $760.90
| Professional | | $514.65 | $669.59 | $760.90 |
- 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
- $545.96 / $732.33 / $965.58
| Professional | | $545.96 | $732.33 | $965.58 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $517.22 / $3,098.10 / $8,000.00
| Professional | | $517.22 | $3,098.10 | $8,000.00 |