- 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
- $985.23 / $1,207.39 / $1,448.87
| Professional | | $985.23 | $1,207.39 | $1,448.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,239.96 / $1,357.00 / $1,643.91
| Professional | | $1,239.96 | $1,357.00 | $1,643.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,062.50 / $1,159.08 / $1,352.27
| Professional | | $1,062.50 | $1,159.08 | $1,352.27 |
- 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
- $985.23 / $1,207.39 / $2,395.48
| Professional | | $985.23 | $1,207.39 | $2,395.48 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $873.21 / $2,650.00 / $6,124.00
| Professional | | $873.21 | $2,650.00 | $6,124.00 |