- 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
- $313.32 / $467.87 / $597.72
| Professional | | $313.32 | $467.87 | $597.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $551.87 / $717.78 / $861.33
| Professional | | $551.87 | $717.78 | $861.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $577.19 / $672.46 / $880.28
| Professional | | $577.19 | $672.46 | $880.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415.37 / $608.66 / $717.78
| Professional | | $415.37 | $608.66 | $717.78 |
- 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
- $563.09 / $716.45 / $919.94
| Professional | | $563.09 | $716.45 | $919.94 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $488.68 / $2,500.00 / $6,063.00
| Professional | | $488.68 | $2,500.00 | $6,063.00 |