- 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
- $255.43 / $397.43 / $723.46
| Professional | | $255.43 | $397.43 | $723.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.02 / $554.25 / $665.10
| Professional | | $432.02 | $554.25 | $665.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $433.74 / $510.00 / $681.30
| Professional | | $433.74 | $510.00 | $681.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.17 / $470.00 / $554.25
| Professional | | $313.17 | $470.00 | $554.25 |
- 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
- $412.27 / $553.79 / $717.65
| Professional | | $412.27 | $553.79 | $717.65 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.48 / $2,500.00 / $6,063.00
| Professional | | $379.48 | $2,500.00 | $6,063.00 |