- 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
- $332.30 / $401.06 / $500.23
| Professional | | $332.30 | $401.06 | $500.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.99 / $316.16 / $379.40
| Professional | | $257.99 | $316.16 | $379.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.21 / $600.12 / $752.60
| Professional | | $515.21 | $600.12 | $752.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.31 / $268.11 / $316.16
| Professional | | $152.31 | $268.11 | $316.16 |
- 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
- $257.99 / $320.95 / $735.18
| Professional | | $257.99 | $320.95 | $735.18 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.18 / $2,500.00 / $6,063.00
| Professional | | $235.18 | $2,500.00 | $6,063.00 |