- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,583.13 / $3,107.00 / $8,431.00
| Facility | | $2,583.13 | $3,107.00 | $8,431.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,699.49 / $1,699.49 / $1,699.49
| Professional | | $1,699.49 | $1,699.49 | $1,699.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,671.51 / $1,934.61 / $2,321.54
| Professional | | $1,671.51 | $1,934.61 | $2,321.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,054.05 / $2,247.94 / $2,723.19
| Professional | | $2,054.05 | $2,247.94 | $2,723.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,702.46 / $1,857.23 / $2,166.77
| Professional | | $1,702.46 | $1,857.23 | $2,166.77 |
- 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
- $1,375.54 / $1,876.16 / $2,397.19
| Professional | | $1,375.54 | $1,876.16 | $2,397.19 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,422.36 / $5,316.74 / $11,157.30
| Professional | | $1,422.36 | $5,316.74 | $11,157.30 |