- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.88 / $2,747.00 / $3,883.00
| Facility | | $1,157.88 | $2,747.00 | $3,883.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,141.32 / $1,141.32 / $1,141.32
| Professional | | $1,141.32 | $1,141.32 | $1,141.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,187.34 / $1,526.65 / $1,831.98
| Professional | | $1,187.34 | $1,526.65 | $1,831.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,655.13 / $1,859.59 / $8,430.00
| Professional | | $1,655.13 | $1,859.59 | $8,430.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,343.45 / $1,465.58 / $1,709.85
| Professional | | $1,343.45 | $1,465.58 | $1,709.85 |
- 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
- $1,245.75 / $1,526.65 / $2,065.89
| Professional | | $1,245.75 | $1,526.65 | $2,065.89 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,125.68 / $2,220.92 / $5,304.00
| Professional | | $1,125.68 | $2,220.92 | $5,304.00 |