- 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
- $979.72 / $1,104.41 / $1,604.17
| Professional | | $979.72 | $1,104.41 | $1,604.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,079.84 / $1,249.83 / $1,499.79
| Professional | | $1,079.84 | $1,249.83 | $1,499.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,315.01 / $1,477.45 / $7,637.00
| Professional | | $1,315.01 | $1,477.45 | $7,637.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,099.84 / $1,199.83 / $1,399.80
| Professional | | $1,099.84 | $1,199.83 | $1,399.80 |
- 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
- $911.90 / $1,213.75 / $1,585.73
| Professional | | $911.90 | $1,213.75 | $1,585.73 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $898.63 / $2,575.00 / $6,124.00
| Professional | | $898.63 | $2,575.00 | $6,124.00 |