- 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
- $2,216.32 / $2,216.32 / $2,216.32
| Professional | | $2,216.32 | $2,216.32 | $2,216.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,340.67 / $2,340.67 / $2,876.39
| Professional | | $2,340.67 | $2,340.67 | $2,876.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,048.47 / $3,336.22 / $4,124.41
| Professional | | $3,048.47 | $3,336.22 | $4,124.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,059.79 / $2,247.05 / $2,621.56
| Professional | | $2,059.79 | $2,247.05 | $2,621.56 |
- 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
- $1,909.99 / $2,464.89 / $3,168.21
| Professional | | $1,909.99 | $2,464.89 | $3,168.21 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $2,420.00 / $2,625.09
| Professional | | $29.27 | $2,420.00 | $2,625.09 |