- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,865.69 / $2,300.00 / $9,506.00
| Professional | | $1,865.69 | $2,300.00 | $9,506.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,175.62 / $3,031.46 / $3,031.46
| Professional | | $2,175.62 | $3,031.46 | $3,031.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.06 / $1,971.51 / $2,843.38
| Professional | | $72.06 | $1,971.51 | $2,843.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,667.69 / $2,910.20 / $3,395.24
| Professional | | $2,667.69 | $2,910.20 | $3,395.24 |
- 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
- $2,425.88 / $3,031.46 / $3,502.95
| Professional | | $2,425.88 | $3,031.46 | $3,502.95 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $413.78 / $2,865.03 / $3,284.37
| Professional | | $413.78 | $2,865.03 | $3,284.37 |