- 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
- $222.93 / $290.73 / $703.44
| Professional | | $222.93 | $290.73 | $703.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.41 / $547.08 / $656.49
| Professional | | $446.41 | $547.08 | $656.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $439.77 / $544.53 / $696.99
| Professional | | $439.77 | $544.53 | $696.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.86 / $437.66 / $547.08
| Professional | | $306.86 | $437.66 | $547.08 |
- 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
- $446.41 / $547.08 / $1,081.68
| Professional | | $446.41 | $547.08 | $1,081.68 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.39 / $349.44 / $3,113.00
| Professional | | $75.39 | $349.44 | $3,113.00 |