- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $6,918.31 / $6,918.31
| Facility | | $2,818.38 | $6,918.31 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $4,897.79 / $8,317.64
| Professional | | $776.25 | $4,897.79 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $7,244.36 / $7,413.10
| Professional | | $758.58 | $7,244.36 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $5,754.40 / $13,803.84
| Professional | | $1,778.28 | $5,754.40 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $6,456.54 / $7,943.28
| Professional | | $758.58 | $6,456.54 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $3,311.31 / $3,311.31
| Facility | | $3,311.31 | $3,311.31 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $6,025.60 / $8,317.64
| Professional | | $1,000.00 | $6,025.60 | $8,317.64 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $9,120.11 / $14,125.38
| Professional | | $1,023.29 | $9,120.11 | $14,125.38 |