- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,747.00 / $6,966.00 / $8,499.00
| Facility | | $2,747.00 | $6,966.00 | $8,499.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,072.17 / $2,072.17 / $2,072.17
| Professional | | $2,072.17 | $2,072.17 | $2,072.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,926.02 / $2,476.17 / $2,971.41
| Professional | | $1,926.02 | $2,476.17 | $2,971.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,624.83 / $2,872.59 / $3,391.43
| Professional | | $2,624.83 | $2,872.59 | $3,391.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,179.03 / $2,377.13 / $2,773.32
| Professional | | $2,179.03 | $2,377.13 | $2,773.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,340.00 / $3,340.00 / $3,340.00
| Facility | | $3,340.00 | $3,340.00 | $3,340.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,020.56 / $2,476.17 / $3,217.26
| Professional | | $2,020.56 | $2,476.17 | $3,217.26 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $2,164.31 / $2,689.14
| Professional | | $29.27 | $2,164.31 | $2,689.14 |