- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,528.00 / $6,084.00 / $7,424.00
| Facility | | $2,528.00 | $6,084.00 | $7,424.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $800.92 / $800.92 / $1,221.66
| Professional | | $800.92 | $800.92 | $1,221.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $787.56 / $981.68 / $981.68
| Professional | | $787.56 | $981.68 | $981.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,051.43 / $1,181.32 / $1,393.96
| Professional | | $1,051.43 | $1,181.32 | $1,393.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $863.87 / $942.41 / $1,099.48
| Professional | | $863.87 | $942.41 | $1,099.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,446.00 / $2,446.00 / $2,446.00
| Facility | | $2,446.00 | $2,446.00 | $2,446.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $936.62 / $994.18 / $1,271.59
| Professional | | $936.62 | $994.18 | $1,271.59 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $718.51 / $1,242.78
| Professional | | $29.27 | $718.51 | $1,242.78 |