- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $4,466.84 / $4,466.84
| Facility | | $1,778.28 | $4,466.84 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $446.68 / $676.08
| Professional | | $416.87 | $446.68 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $549.54 / $676.08
| Professional | | $478.63 | $549.54 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $691.83 / $851.14
| Professional | | $645.65 | $691.83 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $575.44 / $724.44
| Professional | | $512.86 | $575.44 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,071.52 / $1,071.52
| Facility | | $1,071.52 | $1,071.52 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $512.86 / $758.58
| Professional | | $371.54 | $512.86 | $758.58 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $2,570.40 / $6,165.95
| Professional | | $512.86 | $2,570.40 | $6,165.95 |