- 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
- $365.86 / $535.22 / $833.38
| Professional | | $365.86 | $535.22 | $833.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $499.35 / $640.95 / $769.14
| Professional | | $499.35 | $640.95 | $769.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.49 / $616.41 / $796.21
| Professional | | $510.49 | $616.41 | $796.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.67 / $543.53 / $640.95
| Professional | | $370.67 | $543.53 | $640.95 |
- 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
- $501.82 / $640.95 / $821.67
| Professional | | $501.82 | $640.95 | $821.67 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.82 / $2,500.00 / $6,063.00
| Professional | | $460.82 | $2,500.00 | $6,063.00 |