- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,861.43 / $2,747.00 / $6,084.00
| Facility | | $1,861.43 | $2,747.00 | $6,084.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $677.21 / $727.26 / $858.10
| Professional | | $677.21 | $727.26 | $858.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,749.74 / $1,749.74 / $1,749.74
| Facility | | $1,749.74 | $1,749.74 | $1,749.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $757.15 / $934.75 / $1,695.50
| Professional | | $757.15 | $934.75 | $1,695.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,029.33 / $1,156.50 / $1,329.98
| Professional | | $1,029.33 | $1,156.50 | $1,329.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $819.74 / $928.01 / $1,082.68
| Professional | | $819.74 | $928.01 | $1,082.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $2,912.00 / $2,912.00
| Facility | | $2,912.00 | $2,912.00 | $2,912.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $671.72 / $966.68 / $1,249.38
| Professional | | $671.72 | $966.68 | $1,249.38 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $697.96 / $3,692.19 / $9,324.00
| Professional | | $697.96 | $3,692.19 | $9,324.00 |