- 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
- $234.31 / $355.98 / $527.96
| Professional | | $234.31 | $355.98 | $527.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.18 / $502.08 / $588.36
| Professional | | $349.18 | $502.08 | $588.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $518.21 / $604.87 / $729.40
| Professional | | $518.21 | $604.87 | $729.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.86 / $517.76 / $658.97
| Professional | | $364.86 | $517.76 | $658.97 |
- 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
- $480.10 / $588.36 / $764.39
| Professional | | $480.10 | $588.36 | $764.39 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $394.10 / $2,575.00 / $6,124.00
| Professional | | $394.10 | $2,575.00 | $6,124.00 |