- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,924.00 / $2,747.00 / $5,484.00
| Facility | | $1,924.00 | $2,747.00 | $5,484.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,079.88 / $2,079.88 / $2,079.88
| Professional | | $2,079.88 | $2,079.88 | $2,079.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,898.68 / $2,415.30 / $2,898.36
| Professional | | $1,898.68 | $2,415.30 | $2,898.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,735.65 / $3,073.58 / $3,573.93
| Professional | | $2,735.65 | $3,073.58 | $3,573.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,125.46 / $2,318.69 / $2,705.14
| Professional | | $2,125.46 | $2,318.69 | $2,705.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $2,912.00 / $2,912.00
| Facility | | $2,912.00 | $2,912.00 | $2,912.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,970.88 / $2,415.30 / $3,120.95
| Professional | | $1,970.88 | $2,415.30 | $3,120.95 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $1,891.78 / $3,653.19
| Professional | | $29.27 | $1,891.78 | $3,653.19 |