- 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
- $191.16 / $209.38 / $338.31
| Professional | | $191.16 | $209.38 | $338.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.01 / $264.83 / $355.15
| Professional | | $226.01 | $264.83 | $355.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.66 / $385.82 / $4,116.00
| Professional | | $335.66 | $385.82 | $4,116.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.68 / $312.52 / $397.77
| Professional | | $235.68 | $312.52 | $397.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,689.00 / $1,689.00 / $1,689.00
| Facility | | $1,689.00 | $1,689.00 | $1,689.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.80 / $355.15 / $413.00
| Professional | | $289.80 | $355.15 | $413.00 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.49 / $2,500.00 / $6,063.00
| Professional | | $260.49 | $2,500.00 | $6,063.00 |