- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.88 / $3,883.00 / $7,334.84
| Facility | | $1,157.88 | $3,883.00 | $7,334.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.18 / $401.90 / $618.05
| Professional | | $146.18 | $401.90 | $618.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.14 / $470.18 / $488.98
| Professional | | $173.14 | $470.18 | $488.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.85 / $269.75 / $642.61
| Professional | | $217.85 | $269.75 | $642.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.11 / $413.75 / $526.60
| Professional | | $152.11 | $413.75 | $526.60 |
- 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
- $383.66 / $470.18 / $651.90
| Professional | | $383.66 | $470.18 | $651.90 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.89 / $1,958.52 / $5,287.00
| Professional | | $185.89 | $1,958.52 | $5,287.00 |