- 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
- $436.52 / $602.56 / $870.96
| Professional | | $436.52 | $602.56 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $630.96 / $851.14
| Professional | | $524.81 | $630.96 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $891.25 / $3,981.07
| Professional | | $724.44 | $891.25 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $707.95 / $831.76
| Professional | | $467.74 | $707.95 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $1,995.26 / $1,995.26
| Facility | | $1,995.26 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $630.96 / $954.99
| Professional | | $371.54 | $630.96 | $954.99 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $2,570.40 / $6,165.95
| Professional | | $537.03 | $2,570.40 | $6,165.95 |