- 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
- $1,071.81 / $1,071.81 / $1,590.30
| Professional | | $1,071.81 | $1,071.81 | $1,590.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,290.45 / $1,371.97 / $1,786.32
| Professional | | $1,290.45 | $1,371.97 | $1,786.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,134.76 / $1,293.65 / $13,672.00
| Professional | | $1,134.76 | $1,293.65 | $13,672.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,135.59 / $1,238.83 / $1,445.30
| Professional | | $1,135.59 | $1,238.83 | $1,445.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $3,028.00 / $3,028.00
| Facility | | $3,028.00 | $3,028.00 | $3,028.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,053.01 / $1,297.52 / $1,700.31
| Professional | | $1,053.01 | $1,297.52 | $1,700.31 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $945.77 / $8,108.88 / $12,953.00
| Professional | | $945.77 | $8,108.88 | $12,953.00 |