- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,890.45 / $3,890.45
| Facility | | $1,513.56 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $537.03 / $741.31
| Professional | | $363.08 | $537.03 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $524.81 / $645.65
| Professional | | $457.09 | $524.81 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $741.31 / $912.01
| Professional | | $691.83 | $741.31 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $575.44 / $724.44
| Professional | | $524.81 | $575.44 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,698.24 / $1,698.24
| Facility | | $1,698.24 | $1,698.24 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $562.34 / $776.25
| Professional | | $524.81 | $562.34 | $776.25 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $2,089.30 / $5,370.32
| Professional | | $630.96 | $2,089.30 | $5,370.32 |