- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.00 / $1,449.00 / $2,898.00
| Facility | | $988.00 | $1,449.00 | $2,898.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.53 / $88.50 / $292.16
| Professional | | $46.53 | $88.50 | $292.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.35 / $61.18 / $84.34
| Professional | | $50.35 | $61.18 | $84.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.01 / $102.93 / $116.18
| Professional | | $81.01 | $102.93 | $116.18 |
- 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
- $70.34 / $151.04 / $151.85
| Professional | | $70.34 | $151.04 | $151.85 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.19 / $2,021.27 / $4,023.00
| Professional | | $73.19 | $2,021.27 | $4,023.00 |