- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,324.03 / $2,747.00 / $5,299.00
| Facility | | $1,324.03 | $2,747.00 | $5,299.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.05 / $507.48 / $1,877.00
| Professional | | $284.05 | $507.48 | $1,877.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $545.79 / $706.35 / $847.62
| Professional | | $545.79 | $706.35 | $847.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $597.85 / $696.52 / $834.98
| Professional | | $597.85 | $696.52 | $834.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $443.34 / $604.55 / $706.35
| Professional | | $443.34 | $604.55 | $706.35 |
- 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
- $515.86 / $706.35 / $901.53
| Professional | | $515.86 | $706.35 | $901.53 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.07 / $2,500.00 / $6,063.00
| Professional | | $468.07 | $2,500.00 | $6,063.00 |