- 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
- $546.57 / $662.49 / $1,037.28
| Professional | | $546.57 | $662.49 | $1,037.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.09 / $818.05 / $981.66
| Professional | | $630.09 | $818.05 | $981.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $847.40 / $952.08 / $5,851.00
| Professional | | $847.40 | $952.08 | $5,851.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.88 / $785.33 / $916.22
| Professional | | $719.88 | $785.33 | $916.22 |
- 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
- $633.21 / $743.48 / $1,027.52
| Professional | | $633.21 | $743.48 | $1,027.52 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $780.91 / $2,582.96 / $6,124.00
| Professional | | $780.91 | $2,582.96 | $6,124.00 |