- 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
- $296.01 / $423.48 / $551.90
| Professional | | $296.01 | $423.48 | $551.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.51 / $635.76 / $762.92
| Professional | | $494.51 | $635.76 | $762.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.21 / $627.42 / $787.30
| Professional | | $524.21 | $627.42 | $787.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.04 / $539.13 / $635.76
| Professional | | $382.04 | $539.13 | $635.76 |
- 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
- $507.23 / $635.76 / $829.40
| Professional | | $507.23 | $635.76 | $829.40 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.04 / $2,500.00 / $6,063.00
| Professional | | $437.04 | $2,500.00 | $6,063.00 |