- 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
- $214.15 / $397.08 / $801.76
| Professional | | $214.15 | $397.08 | $801.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $481.80 / $612.70 / $735.24
| Professional | | $481.80 | $612.70 | $735.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.14 / $458.03 / $771.93
| Professional | | $393.14 | $458.03 | $771.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.70 / $519.57 / $612.70
| Professional | | $276.70 | $519.57 | $612.70 |
- 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
- $499.96 / $608.30 / $799.02
| Professional | | $499.96 | $608.30 | $799.02 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.85 / $2,500.00 / $6,063.00
| Professional | | $332.85 | $2,500.00 | $6,063.00 |