- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $242.85 / $511.50 / $2,898.00
| Facility | | $242.85 | $511.50 | $2,898.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.11 / $285.74 / $551.95
| Professional | | $257.11 | $285.74 | $551.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.71 / $427.34 / $512.80
| Professional | | $348.71 | $427.34 | $512.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.63 / $492.81 / $2,077.00
| Professional | | $438.63 | $492.81 | $2,077.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.39 / $410.24 / $462.49
| Professional | | $363.39 | $410.24 | $462.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,078.00 / $1,078.00 / $1,078.00
| Facility | | $1,078.00 | $1,078.00 | $1,078.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.81 / $427.34 / $523.22
| Professional | | $321.81 | $427.34 | $523.22 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.42 / $373.36 / $451.38
| Professional | | $56.42 | $373.36 | $451.38 |