- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,861.43 / $2,747.00 / $6,084.00
| Facility | | $1,861.43 | $2,747.00 | $6,084.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,696.94 / $1,696.94 / $1,696.94
| Professional | | $1,696.94 | $1,696.94 | $1,696.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,663.59 / $2,055.03 / $2,466.03
| Professional | | $1,663.59 | $2,055.03 | $2,466.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,143.98 / $2,408.83 / $5,851.00
| Professional | | $2,143.98 | $2,408.83 | $5,851.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,808.42 / $1,972.82 / $2,301.63
| Professional | | $1,808.42 | $1,972.82 | $2,301.63 |
- 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
- $1,671.08 / $2,055.03 / $2,667.56
| Professional | | $1,671.08 | $2,055.03 | $2,667.56 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,557.00 / $4,653.22 / $9,324.00
| Professional | | $1,557.00 | $4,653.22 | $9,324.00 |