- 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
- $1,594.79 / $1,594.79 / $1,594.79
| Professional | | $1,594.79 | $1,594.79 | $1,594.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,538.87 / $1,979.10 / $2,374.92
| Professional | | $1,538.87 | $1,979.10 | $2,374.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,087.42 / $2,284.46 / $2,697.07
| Professional | | $2,087.42 | $2,284.46 | $2,697.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,741.61 / $1,899.94 / $2,216.59
| Professional | | $1,741.61 | $1,899.94 | $2,216.59 |
- 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
- $1,614.95 / $1,979.10 / $2,565.71
| Professional | | $1,614.95 | $1,979.10 | $2,565.71 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $1,662.55 / $2,148.10
| Professional | | $29.27 | $1,662.55 | $2,148.10 |