- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $4,456.00 / $5,299.00
| Facility | | $1,758.00 | $4,456.00 | $5,299.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $622.14 / $700.47 / $3,474.20
| Professional | | $622.14 | $700.47 | $3,474.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $701.99 / $879.30 / $879.30
| Professional | | $701.99 | $879.30 | $879.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $946.31 / $1,088.81 / $4,334.00
| Professional | | $946.31 | $1,088.81 | $4,334.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $773.78 / $844.13 / $984.82
| Professional | | $773.78 | $844.13 | $984.82 |
- 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
- $717.51 / $879.30 / $1,135.94
| Professional | | $717.51 | $879.30 | $1,135.94 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $643.54 / $1,173.56
| Professional | | $29.27 | $643.54 | $1,173.56 |