- 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
- $294.72 / $296.08 / $1,309.00
| Professional | | $294.72 | $296.08 | $1,309.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.54 / $348.99 / $354.61
| Professional | | $285.54 | $348.99 | $354.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415.23 / $477.76 / $8,902.00
| Professional | | $415.23 | $477.76 | $8,902.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.11 / $335.03 / $390.87
| Professional | | $307.11 | $335.03 | $390.87 |
- 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
- $284.77 / $350.88 / $457.22
| Professional | | $284.77 | $350.88 | $457.22 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.49 / $2,582.96 / $6,124.00
| Professional | | $309.49 | $2,582.96 | $6,124.00 |