- 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
- $349.01 / $411.35 / $411.35
| Professional | | $349.01 | $411.35 | $411.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.02 / $622.86 / $622.86
| Professional | | $446.02 | $622.86 | $622.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $669.32 / $770.12 / $8,902.00
| Professional | | $669.32 | $770.12 | $8,902.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.12 / $597.95 / $697.61
| Professional | | $548.12 | $597.95 | $697.61 |
- 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
- $508.26 / $622.86 / $751.02
| Professional | | $508.26 | $622.86 | $751.02 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $551.26 / $2,040.00 / $5,304.00
| Professional | | $551.26 | $2,040.00 | $5,304.00 |