- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,324.03 / $2,747.00 / $4,456.00
| Facility | | $1,324.03 | $2,747.00 | $4,456.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,423.06 / $1,641.32 / $1,641.32
| Professional | | $1,423.06 | $1,641.32 | $1,641.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,399.89 / $1,730.30 / $1,937.51
| Professional | | $1,399.89 | $1,730.30 | $1,937.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,051.48 / $2,360.42 / $11,782.00
| Professional | | $2,051.48 | $2,360.42 | $11,782.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,522.66 / $1,661.09 / $1,937.94
| Professional | | $1,522.66 | $1,661.09 | $1,937.94 |
- 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
- $1,411.92 / $1,730.30 / $2,257.14
| Professional | | $1,411.92 | $1,730.30 | $2,257.14 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,582.96 / $6,124.00
| Professional | | $1,106.00 | $2,582.96 | $6,124.00 |