- 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
- $352.34 / $352.34 / $352.34
| Professional | | $352.34 | $352.34 | $352.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $409.25 / $534.44 / $641.33
| Professional | | $409.25 | $534.44 | $641.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.94 / $616.75 / $5,851.00
| Professional | | $548.94 | $616.75 | $5,851.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $470.31 / $513.05 / $598.57
| Professional | | $470.31 | $513.05 | $598.57 |
- 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
- $406.97 / $534.44 / $656.57
| Professional | | $406.97 | $534.44 | $656.57 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $466.66 / $2,575.00 / $6,124.00
| Professional | | $466.66 | $2,575.00 | $6,124.00 |