- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,583.13 / $3,107.00 / $8,431.00
| Facility | | $2,583.13 | $3,107.00 | $8,431.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,569.33 / $1,569.33 / $1,569.33
| Professional | | $1,569.33 | $1,569.33 | $1,569.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,585.30 / $2,027.06 / $2,432.48
| Professional | | $1,585.30 | $2,027.06 | $2,432.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,146.64 / $2,349.27 / $2,773.59
| Professional | | $2,146.64 | $2,349.27 | $2,773.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,783.82 / $1,945.98 / $2,270.31
| Professional | | $1,783.82 | $1,945.98 | $2,270.31 |
- 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
- $1,559.69 / $2,027.06 / $2,650.80
| Professional | | $1,559.69 | $2,027.06 | $2,650.80 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,466.94 / $5,316.74 / $11,157.30
| Professional | | $1,466.94 | $5,316.74 | $11,157.30 |