- 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
- $439.30 / $439.30 / $497.81
| Professional | | $439.30 | $439.30 | $497.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.65 / $566.73 / $680.07
| Professional | | $489.65 | $566.73 | $680.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.85 / $665.99 / $4,765.00
| Professional | | $583.85 | $665.99 | $4,765.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.25 / $498.72 / $589.39
| Professional | | $440.25 | $498.72 | $589.39 |
- 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
- $468.07 / $546.33 / $722.07
| Professional | | $468.07 | $546.33 | $722.07 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $431.12 / $1,958.52 / $5,287.00
| Professional | | $431.12 | $1,958.52 | $5,287.00 |