- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,528.00 / $2,747.00 / $6,084.00
| Facility | | $2,528.00 | $2,747.00 | $6,084.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,734.72 / $2,734.72 / $2,734.72
| Professional | | $2,734.72 | $2,734.72 | $2,734.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,676.66 / $3,434.31 / $4,121.18
| Professional | | $2,676.66 | $3,434.31 | $4,121.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,636.35 / $3,979.59 / $4,698.38
| Professional | | $3,636.35 | $3,979.59 | $4,698.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,022.20 / $3,296.94 / $3,846.43
| Professional | | $3,022.20 | $3,296.94 | $3,846.43 |
- 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
- $2,802.40 / $3,434.31 / $4,485.05
| Professional | | $2,802.40 | $3,434.31 | $4,485.05 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $2,706.73 / $3,742.04
| Professional | | $29.27 | $2,706.73 | $3,742.04 |