- 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
- $347.62 / $347.62 / $465.25
| Professional | | $347.62 | $347.62 | $465.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.94 / $599.30 / $719.18
| Professional | | $458.94 | $599.30 | $719.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.77 / $605.67 / $728.73
| Professional | | $516.77 | $605.67 | $728.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.09 / $510.12 / $599.30
| Professional | | $374.09 | $510.12 | $599.30 |
- 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
- $485.27 / $591.74 / $793.26
| Professional | | $485.27 | $591.74 | $793.26 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $422.28 / $1,958.52 / $5,287.00
| Professional | | $422.28 | $1,958.52 | $5,287.00 |