- 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
- $280.83 / $434.43 / $961.76
| Professional | | $280.83 | $434.43 | $961.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $546.75 / $736.30 / $883.56
| Professional | | $546.75 | $736.30 | $883.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $527.76 / $614.86 / $842.48
| Professional | | $527.76 | $614.86 | $842.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $405.92 / $624.38 / $736.30
| Professional | | $405.92 | $624.38 | $736.30 |
- 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
- $517.62 / $713.85 / $849.06
| Professional | | $517.62 | $713.85 | $849.06 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.65 / $2,500.00 / $6,063.00
| Professional | | $453.65 | $2,500.00 | $6,063.00 |