- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,818.38 / $4,466.84
| Facility | | $1,778.28 | $2,818.38 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $354.81 / $501.19
| Professional | | $288.40 | $354.81 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $389.05 / $489.78
| Professional | | $346.74 | $389.05 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $512.86 / $630.96
| Professional | | $467.74 | $512.86 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $398.11 / $489.78
| Professional | | $346.74 | $398.11 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $1,096.48
| Facility | | $1,096.48 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $398.11 / $575.44
| Professional | | $288.40 | $398.11 | $575.44 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $2,691.53 / $6,165.95
| Professional | | $436.52 | $2,691.53 | $6,165.95 |