- 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
- $344.41 / $386.70 / $653.27
| Professional | | $344.41 | $386.70 | $653.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.68 / $376.68 / $466.21
| Professional | | $376.68 | $376.68 | $466.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $480.48 / $552.83 / $8,902.00
| Professional | | $480.48 | $552.83 | $8,902.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.47 / $361.61 / $421.88
| Professional | | $331.47 | $361.61 | $421.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $2,155.00 / $2,155.00
| Facility | | $2,155.00 | $2,155.00 | $2,155.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.37 / $386.78 / $499.97
| Professional | | $307.37 | $386.78 | $499.97 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.51 / $2,582.96 / $6,124.00
| Professional | | $410.51 | $2,582.96 | $6,124.00 |