- 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
- $283.80 / $441.29 / $546.14
| Professional | | $283.80 | $441.29 | $546.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.47 / $491.91 / $558.87
| Professional | | $336.47 | $491.91 | $558.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.20 / $542.59 / $688.29
| Professional | | $438.20 | $542.59 | $688.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.01 / $432.88 / $550.94
| Professional | | $309.01 | $432.88 | $550.94 |
- 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
- $401.40 / $497.84 / $682.08
| Professional | | $401.40 | $497.84 | $682.08 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.03 / $1,958.52 / $5,287.00
| Professional | | $333.03 | $1,958.52 | $5,287.00 |