- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,861.43 / $2,747.00 / $6,084.00
| Facility | | $1,861.43 | $2,747.00 | $6,084.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.02 / $289.33 / $289.33
| Professional | | $241.02 | $289.33 | $289.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.83 / $381.60 / $381.60
| Professional | | $313.83 | $381.60 | $381.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.98 / $452.76 / $534.26
| Professional | | $402.98 | $452.76 | $534.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.81 / $366.34 / $427.39
| Professional | | $335.81 | $366.34 | $427.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $2,155.00 / $2,155.00
| Facility | | $2,155.00 | $2,155.00 | $2,155.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.39 / $381.60 / $492.29
| Professional | | $311.39 | $381.60 | $492.29 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.43 / $3,692.19 / $9,324.00
| Professional | | $378.43 | $3,692.19 | $9,324.00 |