- 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
- $517.61 / $579.19 / $658.45
| Professional | | $517.61 | $579.19 | $658.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.02 / $417.66 / $501.20
| Professional | | $327.02 | $417.66 | $501.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $778.18 / $874.31 / $3,857.00
| Professional | | $778.18 | $874.31 | $3,857.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.54 / $400.96 / $467.78
| Professional | | $367.54 | $400.96 | $467.78 |
- 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
- $340.81 / $417.66 / $636.90
| Professional | | $340.81 | $417.66 | $636.90 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.33 / $2,582.96 / $6,124.00
| Professional | | $460.33 | $2,582.96 | $6,124.00 |