- 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
- $1,574.33 / $1,574.33 / $1,574.33
| Professional | | $1,574.33 | $1,574.33 | $1,574.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,524.35 / $1,962.34 / $2,354.81
| Professional | | $1,524.35 | $1,962.34 | $2,354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,066.92 / $2,262.02 / $2,670.59
| Professional | | $2,066.92 | $2,262.02 | $2,670.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,726.86 / $1,883.84 / $2,197.82
| Professional | | $1,726.86 | $1,883.84 | $2,197.82 |
- 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
- $1,598.41 / $1,962.34 / $2,531.48
| Professional | | $1,598.41 | $1,962.34 | $2,531.48 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $1,410.71 / $2,124.36
| Professional | | $29.27 | $1,410.71 | $2,124.36 |