- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,747.00 / $2,747.00 / $2,747.00
| Facility | | $2,747.00 | $2,747.00 | $2,747.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.75 / $260.10 / $329.35
| Professional | | $234.75 | $260.10 | $329.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.76 / $318.08 / $684.81
| Professional | | $279.76 | $318.08 | $684.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.80 / $388.51 / $446.79
| Professional | | $345.80 | $388.51 | $446.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.91 / $305.35 / $356.24
| Professional | | $279.91 | $305.35 | $356.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,446.00 / $2,446.00 / $2,446.00
| Facility | | $2,446.00 | $2,446.00 | $2,446.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.55 / $318.08 / $478.29
| Professional | | $259.55 | $318.08 | $478.29 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.48 / $316.92 / $451.93
| Professional | | $44.48 | $316.92 | $451.93 |