- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,368.58 / $2,684.39 / $3,445.20
| Facility | | $2,368.58 | $2,684.39 | $3,445.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,127.19 / $1,127.19 / $1,127.19
| Professional | | $1,127.19 | $1,127.19 | $1,127.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,445.20 / $3,445.20 / $3,445.20
| Professional | | $3,445.20 | $3,445.20 | $3,445.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,705.65 / $3,244.23 / $3,588.75
| Professional | | $2,705.65 | $3,244.23 | $3,588.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,158.10 / $3,445.20 / $4,019.40
| Professional | | $3,158.10 | $3,445.20 | $4,019.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,126.78 / $4,306.50 / $4,306.50
| Professional | | $2,126.78 | $4,306.50 | $4,306.50 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,440.35 / $4,220.37 / $6,459.75
| Professional | | $2,440.35 | $4,220.37 | $6,459.75 |