- 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
- $202.06 / $276.45 / $535.87
| Professional | | $202.06 | $276.45 | $535.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.53 / $499.66 / $599.60
| Professional | | $404.53 | $499.66 | $599.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.69 / $715.65 / $884.04
| Professional | | $592.69 | $715.65 | $884.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.22 / $423.71 / $499.66
| Professional | | $195.22 | $423.71 | $499.66 |
- 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
- $407.72 / $499.66 / $684.65
| Professional | | $407.72 | $499.66 | $684.65 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.42 / $2,458.57 / $6,063.00
| Professional | | $242.42 | $2,458.57 | $6,063.00 |