- 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
- $369.83 / $451.01 / $689.53
| Professional | | $369.83 | $451.01 | $689.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415.72 / $541.64 / $649.97
| Professional | | $415.72 | $541.64 | $649.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $632.57 / $710.71 / $3,857.00
| Professional | | $632.57 | $710.71 | $3,857.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.64 / $519.97 / $606.63
| Professional | | $476.64 | $519.97 | $606.63 |
- 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
- $441.98 / $541.64 / $673.22
| Professional | | $441.98 | $541.64 | $673.22 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $517.91 / $2,040.00 / $5,304.00
| Professional | | $517.91 | $2,040.00 | $5,304.00 |