- 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
- $252.52 / $264.82 / $1,036.82
| Professional | | $252.52 | $264.82 | $1,036.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.41 / $297.99 / $302.26
| Professional | | $243.41 | $297.99 | $302.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.15 / $408.63 / $8,902.00
| Professional | | $355.15 | $408.63 | $8,902.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.23 / $286.07 / $333.75
| Professional | | $262.23 | $286.07 | $333.75 |
- 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
- $243.16 / $298.95 / $389.61
| Professional | | $243.16 | $298.95 | $389.61 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.52 / $2,040.00 / $5,304.00
| Professional | | $263.52 | $2,040.00 | $5,304.00 |