- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,528.00 / $6,084.00 / $7,424.00
| Facility | | $2,528.00 | $6,084.00 | $7,424.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,314.60 / $1,314.60 / $1,316.46
| Professional | | $1,314.60 | $1,314.60 | $1,316.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,283.34 / $1,594.03 / $1,594.03
| Professional | | $1,283.34 | $1,594.03 | $1,594.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,731.57 / $1,992.32 / $11,782.00
| Professional | | $1,731.57 | $1,992.32 | $11,782.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,402.74 / $1,530.26 / $1,785.31
| Professional | | $1,402.74 | $1,530.26 | $1,785.31 |
- 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
- $1,300.72 / $1,598.32 / $2,092.29
| Professional | | $1,300.72 | $1,598.32 | $2,092.29 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.92 / $1,566.92 / $2,243.07
| Professional | | $219.92 | $1,566.92 | $2,243.07 |