- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,861.43 / $2,747.00 / $6,084.00
| Facility | | $1,861.43 | $2,747.00 | $6,084.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,481.35 / $1,481.35 / $1,481.35
| Professional | | $1,481.35 | $1,481.35 | $1,481.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,460.86 / $1,690.81 / $2,028.98
| Professional | | $1,460.86 | $1,690.81 | $2,028.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,772.76 / $2,022.17 / $4,765.00
| Professional | | $1,772.76 | $2,022.17 | $4,765.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,487.92 / $1,623.18 / $1,893.71
| Professional | | $1,487.92 | $1,623.18 | $1,893.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $2,155.00 / $2,155.00
| Facility | | $2,155.00 | $2,155.00 | $2,155.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,192.30 / $1,638.16 / $2,082.65
| Professional | | $1,192.30 | $1,638.16 | $2,082.65 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,229.94 / $3,692.19 / $9,324.00
| Professional | | $1,229.94 | $3,692.19 | $9,324.00 |