- 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
- $320.74 / $403.33 / $593.22
| Professional | | $320.74 | $403.33 | $593.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.17 / $607.85 / $729.42
| Professional | | $525.17 | $607.85 | $729.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $564.62 / $664.26 / $4,284.89
| Professional | | $564.62 | $664.26 | $4,284.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.76 / $534.91 / $607.85
| Professional | | $416.76 | $534.91 | $607.85 |
- 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
- $431.05 / $582.11 / $767.45
| Professional | | $431.05 | $582.11 | $767.45 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.82 / $2,500.00 / $6,063.00
| Professional | | $448.82 | $2,500.00 | $6,063.00 |