- 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
- $603.07 / $719.66 / $1,105.02
| Professional | | $603.07 | $719.66 | $1,105.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $747.52 / $865.19 / $1,038.23
| Professional | | $747.52 | $865.19 | $1,038.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $900.50 / $1,011.74 / $7,637.00
| Professional | | $900.50 | $1,011.74 | $7,637.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $761.37 / $830.58 / $969.01
| Professional | | $761.37 | $830.58 | $969.01 |
- 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
- $643.39 / $840.09 / $1,109.51
| Professional | | $643.39 | $840.09 | $1,109.51 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $678.53 / $2,582.96 / $6,124.00
| Professional | | $678.53 | $2,582.96 | $6,124.00 |