- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,324.03 / $2,747.00 / $4,456.00
| Facility | | $1,324.03 | $2,747.00 | $4,456.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.58 / $540.58 / $540.58
| Professional | | $540.58 | $540.58 | $540.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $598.23 / $776.20 / $931.44
| Professional | | $598.23 | $776.20 | $931.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.08 / $975.19 / $1,151.33
| Professional | | $891.08 | $975.19 | $1,151.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $683.06 / $745.15 / $869.34
| Professional | | $683.06 | $745.15 | $869.34 |
- 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
- $633.38 / $800.62 / $968.43
| Professional | | $633.38 | $800.62 | $968.43 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $737.45 / $2,582.96 / $6,124.00
| Professional | | $737.45 | $2,582.96 | $6,124.00 |