- 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
- $318.45 / $333.62 / $1,189.00
| Professional | | $318.45 | $333.62 | $1,189.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.30 / $428.85 / $428.85
| Professional | | $308.30 | $428.85 | $428.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.45 / $513.96 / $606.47
| Professional | | $457.45 | $513.96 | $606.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.39 / $411.70 / $480.31
| Professional | | $377.39 | $411.70 | $480.31 |
- 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
- $349.94 / $428.85 / $531.33
| Professional | | $349.94 | $428.85 | $531.33 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.07 / $2,582.96 / $6,124.00
| Professional | | $467.07 | $2,582.96 | $6,124.00 |