- 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
- $2,399.88 / $2,399.88 / $2,399.88
| Professional | | $2,399.88 | $2,399.88 | $2,399.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,101.69 / $2,673.54 / $3,208.25
| Professional | | $2,101.69 | $2,673.54 | $3,208.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,839.57 / $3,190.34 / $3,709.70
| Professional | | $2,839.57 | $3,190.34 | $3,709.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,352.71 / $2,566.60 / $2,994.36
| Professional | | $2,352.71 | $2,566.60 | $2,994.36 |
- 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
- $2,181.61 / $2,673.54 / $3,458.46
| Professional | | $2,181.61 | $2,673.54 | $3,458.46 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $1,940.46 / $4,162.21
| Professional | | $29.27 | $1,940.46 | $4,162.21 |