- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.00 / $2,898.00 / $3,444.00
| Facility | | $988.00 | $2,898.00 | $3,444.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.13 / $39.11 / $177.00
| Professional | | $29.13 | $39.11 | $177.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.13 / $44.40 / $47.29
| Professional | | $35.13 | $44.40 | $47.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.05 / $51.90 / $58.32
| Professional | | $45.05 | $51.90 | $58.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.57 / $41.61 / $52.96
| Professional | | $30.57 | $41.61 | $52.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,078.00 / $1,078.00 / $1,078.00
| Facility | | $1,078.00 | $1,078.00 | $1,078.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.59 / $47.29 / $62.19
| Professional | | $38.59 | $47.29 | $62.19 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.53 / $34.22 / $52.61
| Professional | | $25.53 | $34.22 | $52.61 |