- 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
- $1,004.99 / $1,044.93 / $1,044.93
| Professional | | $1,004.99 | $1,044.93 | $1,044.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $987.79 / $1,224.09 / $1,247.00
| Professional | | $987.79 | $1,224.09 | $1,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,453.10 / $1,632.60 / $1,926.47
| Professional | | $1,453.10 | $1,632.60 | $1,926.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,077.21 / $1,175.14 / $1,370.99
| Professional | | $1,077.21 | $1,175.14 | $1,370.99 |
- 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
- $998.87 / $1,224.09 / $1,591.11
| Professional | | $998.87 | $1,224.09 | $1,591.11 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $886.93 / $2,582.96 / $6,124.00
| Professional | | $886.93 | $2,582.96 | $6,124.00 |