- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.88 / $2,747.00 / $3,883.00
| Facility | | $1,157.88 | $2,747.00 | $3,883.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $466.68 / $579.08 / $934.94
| Professional | | $466.68 | $579.08 | $934.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.30 / $720.96 / $865.16
| Professional | | $588.30 | $720.96 | $865.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $694.04 / $799.41 / $953.81
| Professional | | $694.04 | $799.41 | $953.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.17 / $634.45 / $720.96
| Professional | | $501.17 | $634.45 | $720.96 |
- 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
- $574.41 / $702.93 / $938.63
| Professional | | $574.41 | $702.93 | $938.63 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $522.66 / $1,958.52 / $5,287.00
| Professional | | $522.66 | $1,958.52 | $5,287.00 |