- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,924.00 / $5,484.00 / $6,718.00
| Facility | | $1,924.00 | $5,484.00 | $6,718.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,206.56 / $4,683.09 / $7,070.20
| Professional | | $4,206.56 | $4,683.09 | $7,070.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,858.62 / $5,791.90 / $12,247.74
| Professional | | $4,858.62 | $5,791.90 | $12,247.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,261.83 / $7,035.35 / $8,090.65
| Professional | | $6,261.83 | $7,035.35 | $8,090.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,911.53 / $5,560.22 / $6,486.93
| Professional | | $4,911.53 | $5,560.22 | $6,486.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,446.00 / $2,446.00 / $2,446.00
| Facility | | $2,446.00 | $2,446.00 | $2,446.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,697.03 / $6,001.76 / $8,651.62
| Professional | | $4,697.03 | $6,001.76 | $8,651.62 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $4,336.97 / $7,229.32
| Professional | | $29.27 | $4,336.97 | $7,229.32 |