- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,747.00 / $6,966.00 / $8,499.00
| Facility | | $2,747.00 | $6,966.00 | $8,499.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,797.19 / $1,797.19 / $1,797.19
| Professional | | $1,797.19 | $1,797.19 | $1,797.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,723.18 / $2,208.73 / $2,650.47
| Professional | | $1,723.18 | $2,208.73 | $2,650.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,338.14 / $2,558.84 / $3,021.02
| Professional | | $2,338.14 | $2,558.84 | $3,021.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,943.68 / $2,120.38 / $2,473.77
| Professional | | $1,943.68 | $2,120.38 | $2,473.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $3,028.00 / $3,028.00
| Facility | | $3,028.00 | $3,028.00 | $3,028.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,802.32 / $2,208.73 / $2,818.29
| Professional | | $1,802.32 | $2,208.73 | $2,818.29 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $1,779.76 / $2,406.09
| Professional | | $29.27 | $1,779.76 | $2,406.09 |