- 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
- $500.20 / $548.70 / $934.75
| Professional | | $500.20 | $548.70 | $934.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $582.61 / $725.29 / $870.35
| Professional | | $582.61 | $725.29 | $870.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $742.65 / $834.38 / $5,851.00
| Professional | | $742.65 | $834.38 | $5,851.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $577.74 / $656.53 / $754.30
| Professional | | $577.74 | $656.53 | $754.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,078.00 / $1,078.00 / $1,078.00
| Facility | | $1,078.00 | $1,078.00 | $1,078.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $544.13 / $725.29 / $882.51
| Professional | | $544.13 | $725.29 | $882.51 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.53 / $567.91 / $764.22
| Professional | | $95.53 | $567.91 | $764.22 |