- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,861.43 / $2,747.00 / $6,084.00
| Facility | | $1,861.43 | $2,747.00 | $6,084.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.92 / $388.37 / $682.40
| Professional | | $311.92 | $388.37 | $682.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.75 / $458.73 / $538.76
| Professional | | $381.75 | $458.73 | $538.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.55 / $416.50 / $585.46
| Professional | | $74.55 | $416.50 | $585.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $409.10 / $517.21 / $603.41
| Professional | | $409.10 | $517.21 | $603.41 |
- 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
- $439.63 / $538.76 / $655.82
| Professional | | $439.63 | $538.76 | $655.82 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.45 / $3,600.00 / $9,057.00
| Professional | | $453.45 | $3,600.00 | $9,057.00 |