- 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
- $2,266.21 / $2,266.21 / $2,266.21
| Professional | | $2,266.21 | $2,266.21 | $2,266.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,112.77 / $2,716.68 / $3,260.01
| Professional | | $2,112.77 | $2,716.68 | $3,260.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,875.04 / $3,146.42 / $3,714.72
| Professional | | $2,875.04 | $3,146.42 | $3,714.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,390.67 / $2,608.01 / $3,042.68
| Professional | | $2,390.67 | $2,608.01 | $3,042.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,340.00 / $3,340.00 / $3,340.00
| Facility | | $3,340.00 | $3,340.00 | $3,340.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,216.81 / $2,716.68 / $3,518.01
| Professional | | $2,216.81 | $2,716.68 | $3,518.01 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $2,339.44 / $2,948.70
| Professional | | $29.27 | $2,339.44 | $2,948.70 |