- 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
- $441.47 / $506.31 / $824.47
| Professional | | $441.47 | $506.31 | $824.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $492.40 / $640.85 / $769.02
| Professional | | $492.40 | $640.85 | $769.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $648.09 / $739.28 / $3,935.00
| Professional | | $648.09 | $739.28 | $3,935.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $563.95 / $615.22 / $717.75
| Professional | | $563.95 | $615.22 | $717.75 |
- 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
- $515.92 / $640.85 / $786.02
| Professional | | $515.92 | $640.85 | $786.02 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $551.52 / $2,000.00 / $5,304.00
| Professional | | $551.52 | $2,000.00 | $5,304.00 |