- 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
- $954.84 / $993.77 / $1,448.28
| Professional | | $954.84 | $993.77 | $1,448.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $938.22 / $1,164.60 / $1,185.01
| Professional | | $938.22 | $1,164.60 | $1,185.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,388.76 / $1,597.90 / $8,902.00
| Professional | | $1,388.76 | $1,597.90 | $8,902.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,024.85 / $1,118.03 / $1,304.36
| Professional | | $1,024.85 | $1,118.03 | $1,304.36 |
- 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
- $950.32 / $1,164.60 / $1,512.32
| Professional | | $950.32 | $1,164.60 | $1,512.32 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $833.94 / $2,582.96 / $6,124.00
| Professional | | $833.94 | $2,582.96 | $6,124.00 |