- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $273.30 / $538.20 / $2,747.00
| Facility | | $273.30 | $538.20 | $2,747.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.43 / $276.00 / $505.82
| Professional | | $231.43 | $276.00 | $505.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.89 / $425.41 / $510.50
| Professional | | $340.89 | $425.41 | $510.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.75 / $481.71 / $2,077.00
| Professional | | $428.75 | $481.71 | $2,077.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.29 / $390.10 / $442.43
| Professional | | $343.29 | $390.10 | $442.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,078.00 / $1,078.00 / $1,078.00
| Facility | | $1,078.00 | $1,078.00 | $1,078.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.18 / $421.68 / $507.59
| Professional | | $310.18 | $421.68 | $507.59 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.15 / $335.37 / $441.20
| Professional | | $55.15 | $335.37 | $441.20 |