- 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
- $363.79 / $367.70 / $573.36
| Professional | | $363.79 | $367.70 | $573.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.93 / $455.39 / $455.39
| Professional | | $355.93 | $455.39 | $455.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.10 / $604.16 / $4,334.00
| Professional | | $525.10 | $604.16 | $4,334.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.74 / $437.17 / $510.03
| Professional | | $400.74 | $437.17 | $510.03 |
- 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
- $371.60 / $455.39 / $577.04
| Professional | | $371.60 | $455.39 | $577.04 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $431.25 / $2,040.00 / $5,304.00
| Professional | | $431.25 | $2,040.00 | $5,304.00 |