- 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
- $261.36 / $317.66 / $528.91
| Professional | | $261.36 | $317.66 | $528.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.22 / $413.26 / $495.92
| Professional | | $337.22 | $413.26 | $495.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $422.54 / $474.74 / $3,857.00
| Professional | | $422.54 | $474.74 | $3,857.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.92 / $363.67 / $429.79
| Professional | | $319.92 | $363.67 | $429.79 |
- 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
- $323.48 / $413.26 / $520.14
| Professional | | $323.48 | $413.26 | $520.14 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.37 / $2,500.00 / $6,063.00
| Professional | | $340.37 | $2,500.00 | $6,063.00 |