- 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
- $303.52 / $308.67 / $463.51
| Professional | | $303.52 | $308.67 | $463.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.83 / $371.29 / $371.29
| Professional | | $297.83 | $371.29 | $371.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.46 / $489.26 / $577.33
| Professional | | $435.46 | $489.26 | $577.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.73 / $356.44 / $415.84
| Professional | | $326.73 | $356.44 | $415.84 |
- 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
- $302.97 / $371.29 / $479.91
| Professional | | $302.97 | $371.29 | $479.91 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.06 / $2,582.96 / $6,124.00
| Professional | | $355.06 | $2,582.96 | $6,124.00 |