- 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
- $149.21 / $205.03 / $275.51
| Professional | | $149.21 | $205.03 | $275.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.51 / $432.30 / $518.76
| Professional | | $373.51 | $432.30 | $518.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.37 / $361.45 / $3,857.00
| Professional | | $292.37 | $361.45 | $3,857.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.85 / $345.84 / $432.30
| Professional | | $205.85 | $345.84 | $432.30 |
- 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
- $300.58 / $413.18 / $546.26
| Professional | | $300.58 | $413.18 | $546.26 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.54 / $1,958.52 / $5,287.00
| Professional | | $247.54 | $1,958.52 | $5,287.00 |