- 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
- $329.28 / $329.28 / $457.33
| Professional | | $329.28 | $329.28 | $457.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $422.32 / $542.70 / $651.24
| Professional | | $422.32 | $542.70 | $651.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $449.47 / $531.50 / $642.33
| Professional | | $449.47 | $531.50 | $642.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.72 / $460.21 / $542.70
| Professional | | $317.72 | $460.21 | $542.70 |
- 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
- $435.95 / $542.70 / $712.31
| Professional | | $435.95 | $542.70 | $712.31 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.76 / $1,958.52 / $5,287.00
| Professional | | $376.76 | $1,958.52 | $5,287.00 |