- 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
- $302.27 / $551.20 / $837.38
| Professional | | $302.27 | $551.20 | $837.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $550.91 / $637.63 / $765.15
| Professional | | $550.91 | $637.63 | $765.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $466.46 / $542.98 / $3,857.00
| Professional | | $466.46 | $542.98 | $3,857.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.50 / $512.04 / $637.63
| Professional | | $375.50 | $512.04 | $637.63 |
- 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
- $443.43 / $608.75 / $809.21
| Professional | | $443.43 | $608.75 | $809.21 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.22 / $2,500.00 / $6,063.00
| Professional | | $448.22 | $2,500.00 | $6,063.00 |