- 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
- $326.68 / $368.95 / $412.27
| Professional | | $326.68 | $368.95 | $412.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.81 / $461.88 / $461.88
| Professional | | $358.81 | $461.88 | $461.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $492.45 / $566.60 / $8,902.00
| Professional | | $492.45 | $566.60 | $8,902.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $406.45 / $443.40 / $517.29
| Professional | | $406.45 | $443.40 | $517.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $3,028.00 / $3,028.00
| Facility | | $3,028.00 | $3,028.00 | $3,028.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.89 / $461.88 / $592.71
| Professional | | $376.89 | $461.88 | $592.71 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $502.81 / $2,582.96 / $6,124.00
| Professional | | $502.81 | $2,582.96 | $6,124.00 |