- 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
- $298.02 / $315.07 / $315.07
| Professional | | $298.02 | $315.07 | $315.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.48 / $350.71 / $359.76
| Professional | | $287.48 | $350.71 | $359.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.46 / $464.22 / $6,874.20
| Professional | | $403.46 | $464.22 | $6,874.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.63 / $336.68 / $392.80
| Professional | | $308.63 | $336.68 | $392.80 |
- 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
- $286.18 / $352.58 / $459.24
| Professional | | $286.18 | $352.58 | $459.24 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.81 / $2,575.00 / $6,124.00
| Professional | | $318.81 | $2,575.00 | $6,124.00 |