- 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
- $273.63 / $384.20 / $848.30
| Professional | | $273.63 | $384.20 | $848.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $518.28 / $650.48 / $780.57
| Professional | | $518.28 | $650.48 | $780.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.07 / $600.79 / $773.78
| Professional | | $508.07 | $600.79 | $773.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.55 / $551.60 / $650.48
| Professional | | $356.55 | $551.60 | $650.48 |
- 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
- $493.47 / $650.48 / $810.98
| Professional | | $493.47 | $650.48 | $810.98 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.25 / $2,000.00 / $5,304.00
| Professional | | $222.25 | $2,000.00 | $5,304.00 |