- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.88 / $2,747.00 / $3,883.00
| Facility | | $1,157.88 | $2,747.00 | $3,883.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.04 / $458.00 / $548.94
| Professional | | $359.04 | $458.00 | $548.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.44 / $351.20 / $421.44
| Professional | | $303.44 | $351.20 | $421.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $591.01 / $664.01 / $2,540.00
| Professional | | $591.01 | $664.01 | $2,540.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.87 / $309.06 / $351.20
| Professional | | $244.87 | $309.06 | $351.20 |
- 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
- $303.44 / $351.47 / $861.26
| Professional | | $303.44 | $351.47 | $861.26 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.49 / $338.36 / $4,597.00
| Professional | | $47.49 | $338.36 | $4,597.00 |