- 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
- $107.40 / $133.19 / $674.00
| Professional | | $107.40 | $133.19 | $674.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.66 / $158.25 / $162.47
| Professional | | $132.66 | $158.25 | $162.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.22 / $217.71 / $2,342.00
| Professional | | $189.22 | $217.71 | $2,342.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.26 / $151.91 / $177.24
| Professional | | $139.26 | $151.91 | $177.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $2,155.00 / $2,155.00
| Facility | | $2,155.00 | $2,155.00 | $2,155.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.13 / $158.25 / $206.82
| Professional | | $129.13 | $158.25 | $206.82 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.60 / $3,600.00 / $9,057.00
| Professional | | $153.60 | $3,600.00 | $9,057.00 |