- 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
- $475.01 / $475.01 / $475.01
| Professional | | $475.01 | $475.01 | $475.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $409.02 / $534.80 / $641.78
| Professional | | $409.02 | $534.80 | $641.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $598.78 / $655.29 / $773.66
| Professional | | $598.78 | $655.29 | $773.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $470.64 / $513.41 / $598.99
| Professional | | $470.64 | $513.41 | $598.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $2,155.00 / $2,155.00
| Facility | | $2,155.00 | $2,155.00 | $2,155.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.41 / $534.80 / $779.09
| Professional | | $436.41 | $534.80 | $779.09 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.96 / $2,575.00 / $6,124.00
| Professional | | $513.96 | $2,575.00 | $6,124.00 |