- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,924.00 / $2,747.00 / $5,484.00
| Facility | | $1,924.00 | $2,747.00 | $5,484.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,746.17 / $3,746.17 / $3,746.17
| Professional | | $3,746.17 | $3,746.17 | $3,746.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,688.11 / $4,705.01 / $5,646.02
| Professional | | $3,688.11 | $4,705.01 | $5,646.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,019.68 / $5,493.48 / $6,485.71
| Professional | | $5,019.68 | $5,493.48 | $6,485.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,140.41 / $4,516.81 / $5,269.61
| Professional | | $4,140.41 | $4,516.81 | $5,269.61 |
- 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
- $3,839.29 / $4,705.01 / $6,096.24
| Professional | | $3,839.29 | $4,705.01 | $6,096.24 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $3,780.42 / $5,165.57
| Professional | | $29.27 | $3,780.42 | $5,165.57 |