- 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
- $664.08 / $664.08 / $664.08
| Professional | | $664.08 | $664.08 | $664.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $596.00 / $802.01 / $962.42
| Professional | | $596.00 | $802.01 | $962.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $857.82 / $963.79 / $5,851.00
| Professional | | $857.82 | $963.79 | $5,851.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $705.77 / $769.93 / $898.25
| Professional | | $705.77 | $769.93 | $898.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $1,981.00 / $1,981.00
| Facility | | $1,981.00 | $1,981.00 | $1,981.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $642.30 / $802.01 / $1,022.67
| Professional | | $642.30 | $802.01 | $1,022.67 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $655.71 / $2,575.00 / $6,124.00
| Professional | | $655.71 | $2,575.00 | $6,124.00 |