- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,324.03 / $4,285.00 / $4,456.00
| Facility | | $1,324.03 | $4,285.00 | $4,456.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.69 / $540.46 / $583.40
| Professional | | $401.69 | $540.46 | $583.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.52 / $472.56 / $620.12
| Professional | | $387.52 | $472.56 | $620.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $721.01 / $829.59 / $8,902.00
| Professional | | $721.01 | $829.59 | $8,902.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415.86 / $453.66 / $529.27
| Professional | | $415.86 | $453.66 | $529.27 |
- 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
- $385.61 / $477.56 / $621.12
| Professional | | $385.61 | $477.56 | $621.12 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.29 / $2,582.96 / $6,124.00
| Professional | | $456.29 | $2,582.96 | $6,124.00 |