- 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
- $274.67 / $321.81 / $410.67
| Professional | | $274.67 | $321.81 | $410.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $451.28 / $576.01 / $691.22
| Professional | | $451.28 | $576.01 | $691.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $470.31 / $556.14 / $721.03
| Professional | | $470.31 | $556.14 | $721.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.95 / $488.46 / $576.01
| Professional | | $333.95 | $488.46 | $576.01 |
- 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
- $434.28 / $576.01 / $755.37
| Professional | | $434.28 | $576.01 | $755.37 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.40 / $1,958.52 / $5,287.00
| Professional | | $391.40 | $1,958.52 | $5,287.00 |