- 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
- $1,715.19 / $1,715.19 / $1,715.19
| Professional | | $1,715.19 | $1,715.19 | $1,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,681.74 / $2,158.15 / $2,589.78
| Professional | | $1,681.74 | $2,158.15 | $2,589.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,276.85 / $2,491.77 / $2,941.83
| Professional | | $2,276.85 | $2,491.77 | $2,941.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,899.17 / $2,071.82 / $2,417.13
| Professional | | $1,899.17 | $2,071.82 | $2,417.13 |
- 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
- $1,761.05 / $2,158.15 / $2,806.35
| Professional | | $1,761.05 | $2,158.15 | $2,806.35 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $1,829.02 / $2,343.03
| Professional | | $29.27 | $1,829.02 | $2,343.03 |