- 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
- $304.31 / $325.64 / $501.37
| Professional | | $304.31 | $325.64 | $501.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.94 / $380.10 / $458.85
| Professional | | $314.94 | $380.10 | $458.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $499.77 / $574.45 / $5,879.00
| Professional | | $499.77 | $574.45 | $5,879.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.82 / $440.50 / $513.91
| Professional | | $349.82 | $440.50 | $513.91 |
- 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
- $374.42 / $458.85 / $562.54
| Professional | | $374.42 | $458.85 | $562.54 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.85 / $2,507.73 / $6,063.00
| Professional | | $387.85 | $2,507.73 | $6,063.00 |