- 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
- $267.45 / $306.66 / $404.51
| Professional | | $267.45 | $306.66 | $404.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.48 / $545.01 / $654.02
| Professional | | $425.48 | $545.01 | $654.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.63 / $525.77 / $675.14
| Professional | | $444.63 | $525.77 | $675.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.12 / $462.17 / $545.01
| Professional | | $318.12 | $462.17 | $545.01 |
- 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
- $433.77 / $545.01 / $709.20
| Professional | | $433.77 | $545.01 | $709.20 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.94 / $2,500.00 / $6,063.00
| Professional | | $384.94 | $2,500.00 | $6,063.00 |