- 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
- $1,116.66 / $1,664.01 / $9,438.00
| Professional | | $1,116.66 | $1,664.01 | $9,438.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,022.07 / $1,331.78 / $1,598.13
| Professional | | $1,022.07 | $1,331.78 | $1,598.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,390.24 / $1,561.98 / $8,430.00
| Professional | | $1,390.24 | $1,561.98 | $8,430.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,171.96 / $1,278.50 / $1,491.59
| Professional | | $1,171.96 | $1,278.50 | $1,491.59 |
- 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
- $1,058.68 / $1,331.78 / $1,674.68
| Professional | | $1,058.68 | $1,331.78 | $1,674.68 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,005.00 / $2,575.00 / $6,124.00
| Professional | | $1,005.00 | $2,575.00 | $6,124.00 |