- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,528.00 / $6,084.00 / $7,424.00
| Facility | | $2,528.00 | $6,084.00 | $7,424.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $443.27 / $648.21 / $678.24
| Professional | | $443.27 | $648.21 | $678.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $665.15 / $769.85 / $923.82
| Professional | | $665.15 | $769.85 | $923.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $793.00 / $904.57 / $4,765.00
| Professional | | $793.00 | $904.57 | $4,765.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $646.39 / $705.16 / $822.68
| Professional | | $646.39 | $705.16 | $822.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,078.00 / $1,078.00 / $1,078.00
| Facility | | $1,078.00 | $1,078.00 | $1,078.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $563.09 / $745.64 / $980.51
| Professional | | $563.09 | $745.64 | $980.51 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.56 / $646.41 / $828.52
| Professional | | $103.56 | $646.41 | $828.52 |