- 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
- $414.89 / $563.29 / $766.40
| Professional | | $414.89 | $563.29 | $766.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $718.95 / $832.11 / $998.54
| Professional | | $718.95 | $832.11 | $998.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $761.87 / $884.05 / $2,077.00
| Professional | | $761.87 | $884.05 | $2,077.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $538.47 / $732.26 / $832.11
| Professional | | $538.47 | $732.26 | $832.11 |
- 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
- $598.62 / $756.18 / $835.94
| Professional | | $598.62 | $756.18 | $835.94 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $566.44 / $1,958.52 / $5,287.00
| Professional | | $566.44 | $1,958.52 | $5,287.00 |