- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.00 / $2,747.00 / $2,898.00
| Facility | | $988.00 | $2,747.00 | $2,898.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.61 / $571.83 / $2,758.00
| Professional | | $469.61 | $571.83 | $2,758.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.33 / $663.40 / $796.08
| Professional | | $515.33 | $663.40 | $796.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $733.92 / $844.44 / $1,089.23
| Professional | | $733.92 | $844.44 | $1,089.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.79 / $636.86 / $743.01
| Professional | | $583.79 | $636.86 | $743.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $1,106.00 / $1,106.00
| Facility | | $1,106.00 | $1,106.00 | $1,106.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.33 / $663.40 / $840.77
| Professional | | $541.33 | $663.40 | $840.77 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.15 / $707.59 / $3,580.00
| Professional | | $89.15 | $707.59 | $3,580.00 |