- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,324.03 / $2,747.00 / $4,456.00
| Facility | | $1,324.03 | $2,747.00 | $4,456.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,185.74 / $1,185.74 / $1,185.74
| Professional | | $1,185.74 | $1,185.74 | $1,185.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,193.63 / $1,539.64 / $1,847.57
| Professional | | $1,193.63 | $1,539.64 | $1,847.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,547.50 / $1,693.57 / $1,999.46
| Professional | | $1,547.50 | $1,693.57 | $1,999.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,354.88 / $1,478.05 / $1,724.39
| Professional | | $1,354.88 | $1,478.05 | $1,724.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $1,981.00 / $1,981.00
| Facility | | $1,981.00 | $1,981.00 | $1,981.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,142.18 / $1,539.64 / $1,926.44
| Professional | | $1,142.18 | $1,539.64 | $1,926.44 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,582.96 / $6,124.00
| Professional | | $1,106.00 | $2,582.96 | $6,124.00 |