- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,924.00 / $2,747.00 / $5,484.00
| Facility | | $1,924.00 | $2,747.00 | $5,484.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,405.65 / $2,723.18 / $4,179.17
| Professional | | $2,405.65 | $2,723.18 | $4,179.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,500.90 / $3,327.35 / $3,992.82
| Professional | | $2,500.90 | $3,327.35 | $3,992.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,484.12 / $3,812.98 / $4,501.68
| Professional | | $3,484.12 | $3,812.98 | $4,501.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,928.07 / $3,194.26 / $3,726.63
| Professional | | $2,928.07 | $3,194.26 | $3,726.63 |
- 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
- $2,715.12 / $3,327.35 / $4,258.62
| Professional | | $2,715.12 | $3,327.35 | $4,258.62 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $2,901.48 / $4,643.80
| Professional | | $29.27 | $2,901.48 | $4,643.80 |