- 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
- $3,279.87 / $3,279.87 / $3,279.87
| Professional | | $3,279.87 | $3,279.87 | $3,279.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,197.80 / $4,077.90 / $4,893.47
| Professional | | $3,197.80 | $4,077.90 | $4,893.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,443.28 / $4,862.68 / $5,740.98
| Professional | | $4,443.28 | $4,862.68 | $5,740.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,588.55 / $3,914.78 / $4,567.25
| Professional | | $3,588.55 | $3,914.78 | $4,567.25 |
- 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
- $3,327.57 / $4,077.90 / $5,271.65
| Professional | | $3,327.57 | $4,077.90 | $5,271.65 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $3,441.38 / $4,478.97
| Professional | | $29.27 | $3,441.38 | $4,478.97 |