- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,747.00 / $8,431.00 / $10,303.00
| Facility | | $2,747.00 | $8,431.00 | $10,303.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $992.21 / $1,249.70 / $3,909.00
| Professional | | $992.21 | $1,249.70 | $3,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,292.52 / $1,495.98 / $1,795.17
| Professional | | $1,292.52 | $1,495.98 | $1,795.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,553.37 / $1,827.49 / $13,377.00
| Professional | | $1,553.37 | $1,827.49 | $13,377.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,316.46 / $1,436.14 / $1,675.49
| Professional | | $1,316.46 | $1,436.14 | $1,675.49 |
- 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
- $1,111.61 / $1,456.75 / $1,911.30
| Professional | | $1,111.61 | $1,456.75 | $1,911.30 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,083.07 / $5,969.00 / $8,145.00
| Professional | | $1,083.07 | $5,969.00 | $8,145.00 |