- 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
- $1,702.24 / $1,743.77 / $2,697.42
| Professional | | $1,702.24 | $1,743.77 | $2,697.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,700.38 / $2,159.19 / $2,591.03
| Professional | | $1,700.38 | $2,159.19 | $2,591.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,303.76 / $2,521.21 / $2,976.60
| Professional | | $2,303.76 | $2,521.21 | $2,976.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,900.09 / $2,072.82 / $2,418.29
| Professional | | $1,900.09 | $2,072.82 | $2,418.29 |
- 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
- $1,761.90 / $2,159.19 / $2,828.43
| Professional | | $1,761.90 | $2,159.19 | $2,828.43 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.33 / $1,925.72 / $2,370.73
| Professional | | $296.33 | $1,925.72 | $2,370.73 |