- 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
- $247.52 / $279.11 / $383.17
| Professional | | $247.52 | $279.11 | $383.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.47 / $527.45 / $632.94
| Professional | | $414.47 | $527.45 | $632.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.79 / $500.74 / $662.54
| Professional | | $425.79 | $500.74 | $662.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.85 / $447.28 / $527.45
| Professional | | $301.85 | $447.28 | $527.45 |
- 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
- $426.22 / $527.45 / $699.80
| Professional | | $426.22 | $527.45 | $699.80 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.59 / $2,500.00 / $6,063.00
| Professional | | $369.59 | $2,500.00 | $6,063.00 |