- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,528.00 / $2,747.00 / $6,084.00
| Facility | | $2,528.00 | $2,747.00 | $6,084.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,001.22 / $2,141.51 / $5,910.57
| Professional | | $2,001.22 | $2,141.51 | $5,910.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,143.23 / $2,738.03 / $3,285.63
| Professional | | $2,143.23 | $2,738.03 | $3,285.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,906.10 / $3,265.09 / $3,796.61
| Professional | | $2,906.10 | $3,265.09 | $3,796.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,409.46 / $2,628.50 / $3,066.59
| Professional | | $2,409.46 | $2,628.50 | $3,066.59 |
- 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
- $2,234.23 / $2,738.03 / $3,576.98
| Professional | | $2,234.23 | $2,738.03 | $3,576.98 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $1,985.92 / $3,565.53
| Professional | | $29.27 | $1,985.92 | $3,565.53 |