- 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
- $489.23 / $605.05 / $1,034.21
| Professional | | $489.23 | $605.05 | $1,034.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $684.33 / $792.05 / $950.46
| Professional | | $684.33 | $792.05 | $950.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $674.04 / $792.79 / $3,857.00
| Professional | | $674.04 | $792.79 | $3,857.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $486.05 / $662.79 / $792.05
| Professional | | $486.05 | $662.79 | $792.05 |
- 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
- $563.45 / $758.54 / $794.95
| Professional | | $563.45 | $758.54 | $794.95 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $523.09 / $3,098.10 / $8,000.00
| Professional | | $523.09 | $3,098.10 | $8,000.00 |