- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $4,456.00 / $5,299.00
| Facility | | $1,758.00 | $4,456.00 | $5,299.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.06 / $341.22 / $457.34
| Professional | | $241.06 | $341.22 | $457.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.20 / $445.90 / $977.92
| Professional | | $288.20 | $445.90 | $977.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.24 / $487.21 / $637.91
| Professional | | $414.24 | $487.21 | $637.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.56 / $462.95 / $635.41
| Professional | | $300.56 | $462.95 | $635.41 |
- 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
- $370.62 / $566.45 / $718.95
| Professional | | $370.62 | $566.45 | $718.95 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.53 / $360.95 / $4,597.00
| Professional | | $78.53 | $360.95 | $4,597.00 |