- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,747.00 / $2,747.00 / $2,747.00
| Facility | | $2,747.00 | $2,747.00 | $2,747.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,993.49 / $1,993.49 / $1,993.49
| Professional | | $1,993.49 | $1,993.49 | $1,993.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,191.17 / $2,191.17 / $2,597.94
| Professional | | $2,191.17 | $2,191.17 | $2,597.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,736.97 / $2,995.32 / $3,702.97
| Professional | | $2,736.97 | $2,995.32 | $3,702.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,928.23 / $2,103.53 / $2,454.12
| Professional | | $1,928.23 | $2,103.53 | $2,454.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,446.00 / $2,446.00 / $2,446.00
| Facility | | $2,446.00 | $2,446.00 | $2,446.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,788.00 / $2,304.38 / $2,961.65
| Professional | | $1,788.00 | $2,304.38 | $2,961.65 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $2,377.07 / $3,541.09
| Professional | | $29.27 | $2,377.07 | $3,541.09 |