- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,324.03 / $2,747.00 / $4,456.00
| Facility | | $1,324.03 | $2,747.00 | $4,456.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.22 / $412.18 / $1,473.07
| Professional | | $282.22 | $412.18 | $1,473.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.76 / $552.40 / $662.88
| Professional | | $450.76 | $552.40 | $662.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.30 / $537.76 / $720.69
| Professional | | $434.30 | $537.76 | $720.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.38 / $441.92 / $552.40
| Professional | | $285.38 | $441.92 | $552.40 |
- 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
- $450.76 / $552.40 / $1,083.82
| Professional | | $450.76 | $552.40 | $1,083.82 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.40 / $405.90 / $5,885.00
| Professional | | $76.40 | $405.90 | $5,885.00 |