- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,154.19 / $2,154.19 / $2,422.00
| Professional | | $2,154.19 | $2,154.19 | $2,422.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,228.21 / $2,730.65 / $3,276.78
| Professional | | $2,228.21 | $2,730.65 | $3,276.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,664.84 / $2,996.45 / $3,370.23
| Professional | | $2,664.84 | $2,996.45 | $3,370.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,915.65 / $2,402.96 / $2,730.65
| Professional | | $1,915.65 | $2,402.96 | $2,730.65 |
- 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
- $2,228.21 / $2,730.65 / $3,635.66
| Professional | | $2,228.21 | $2,730.65 | $3,635.66 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.07 / $2,127.17 / $2,880.58
| Professional | | $360.07 | $2,127.17 | $2,880.58 |