- 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
- $582.97 / $628.29 / $912.90
| Professional | | $582.97 | $628.29 | $912.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.36 / $713.38 / $856.05
| Professional | | $616.36 | $713.38 | $856.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $740.55 / $871.24 / $6,122.00
| Professional | | $740.55 | $871.24 | $6,122.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $627.77 / $684.84 / $798.98
| Professional | | $627.77 | $684.84 | $798.98 |
- 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
- $526.16 / $691.55 / $910.49
| Professional | | $526.16 | $691.55 | $910.49 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.96 / $2,582.96 / $6,124.00
| Professional | | $513.96 | $2,582.96 | $6,124.00 |