- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,528.00 / $2,747.00 / $6,084.00
| Facility | | $2,528.00 | $2,747.00 | $6,084.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $944.14 / $944.14 / $944.14
| Professional | | $944.14 | $944.14 | $944.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,699.16 / $2,187.04 / $2,624.45
| Professional | | $1,699.16 | $2,187.04 | $2,624.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,535.63 / $1,680.58 / $1,984.12
| Professional | | $1,535.63 | $1,680.58 | $1,984.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,924.59 / $2,099.56 / $2,449.48
| Professional | | $1,924.59 | $2,099.56 | $2,449.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $3,028.00 / $3,028.00
| Facility | | $3,028.00 | $3,028.00 | $3,028.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,085.42 / $2,187.04 / $2,827.22
| Professional | | $1,085.42 | $2,187.04 | $2,827.22 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $1,512.68 / $2,350.53
| Professional | | $29.27 | $1,512.68 | $2,350.53 |