- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,884.03 / $2,884.03
| Facility | | $1,000.00 | $2,884.03 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $575.44 / $831.76
| Professional | | $512.86 | $575.44 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $630.96 / $831.76
| Professional | | $588.84 | $630.96 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $933.25 / $2,570.40
| Professional | | $794.33 | $933.25 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $741.31 / $933.25
| Professional | | $602.56 | $741.31 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,071.52 / $1,071.52
| Facility | | $1,071.52 | $1,071.52 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $630.96 / $870.96
| Professional | | $446.68 | $630.96 | $870.96 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $676.08 / $812.83
| Professional | | $102.33 | $676.08 | $812.83 |