- 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
- $287.54 / $431.63 / $821.13
| Professional | | $287.54 | $431.63 | $821.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $497.59 / $630.84 / $757.01
| Professional | | $497.59 | $630.84 | $757.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $502.95 / $591.54 / $784.07
| Professional | | $502.95 | $591.54 | $784.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.44 / $534.95 / $630.84
| Professional | | $365.44 | $534.95 | $630.84 |
- 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
- $495.92 / $630.84 / $813.06
| Professional | | $495.92 | $630.84 | $813.06 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.82 / $2,500.00 / $6,063.00
| Professional | | $434.82 | $2,500.00 | $6,063.00 |