- 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
- $441.22 / $441.22 / $514.02
| Professional | | $441.22 | $441.22 | $514.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.08 / $420.60 / $504.72
| Professional | | $329.08 | $420.60 | $504.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $522.50 / $587.04 / $2,077.00
| Professional | | $522.50 | $587.04 | $2,077.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.13 / $403.78 / $471.07
| Professional | | $370.13 | $403.78 | $471.07 |
- 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
- $343.21 / $420.60 / $553.58
| Professional | | $343.21 | $420.60 | $553.58 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $413.63 / $1,958.52 / $5,287.00
| Professional | | $413.63 | $1,958.52 | $5,287.00 |