- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.88 / $2,747.00 / $3,883.00
| Facility | | $1,157.88 | $2,747.00 | $3,883.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.44 / $368.33 / $742.36
| Professional | | $214.44 | $368.33 | $742.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.09 / $729.61 / $954.06
| Professional | | $255.09 | $729.61 | $954.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.37 / $368.21 / $1,310.08
| Professional | | $297.37 | $368.21 | $1,310.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.04 / $839.58 / $1,068.55
| Professional | | $185.04 | $839.58 | $1,068.55 |
- 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
- $778.52 / $954.06 / $1,251.51
| Professional | | $778.52 | $954.06 | $1,251.51 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.30 / $1,981.00 / $5,287.00
| Professional | | $227.30 | $1,981.00 | $5,287.00 |