- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,583.13 / $3,107.00 / $8,431.00
| Facility | | $2,583.13 | $3,107.00 | $8,431.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $927.02 / $927.02 / $1,153.58
| Professional | | $927.02 | $927.02 | $1,153.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,255.23 / $1,584.10 / $1,900.92
| Professional | | $1,255.23 | $1,584.10 | $1,900.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.48 / $1,675.09 / $1,885.57
| Professional | | $1,479.48 | $1,675.09 | $1,885.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,065.72 / $1,394.01 / $1,584.10
| Professional | | $1,065.72 | $1,394.01 | $1,584.10 |
- 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
- $1,195.33 / $1,584.10 / $2,010.50
| Professional | | $1,195.33 | $1,584.10 | $2,010.50 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,035.64 / $4,635.00 / $11,157.00
| Professional | | $1,035.64 | $4,635.00 | $11,157.00 |