- 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
- $1,032.05 / $1,032.05 / $1,032.05
| Professional | | $1,032.05 | $1,032.05 | $1,032.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,117.15 / $1,117.15 / $1,335.37
| Professional | | $1,117.15 | $1,117.15 | $1,335.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,449.36 / $1,586.17 / $1,960.90
| Professional | | $1,449.36 | $1,586.17 | $1,960.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $983.09 / $1,072.46 / $1,251.21
| Professional | | $983.09 | $1,072.46 | $1,251.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $2,155.00 / $2,155.00
| Facility | | $2,155.00 | $2,155.00 | $2,155.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $911.59 / $1,158.50 / $1,495.86
| Professional | | $911.59 | $1,158.50 | $1,495.86 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $1,208.34 / $1,806.24
| Professional | | $29.27 | $1,208.34 | $1,806.24 |