- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,884.03 / $2,884.03
| Facility | | $1,000.00 | $2,884.03 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $165.96 / $288.40
| Professional | | $93.33 | $165.96 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $204.17 / $234.42
| Professional | | $204.17 | $204.17 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $194.98 / $2,454.71
| Professional | | $158.49 | $194.98 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $194.98 / $257.04
| Professional | | $93.33 | $194.98 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $1,096.48
| Facility | | $1,096.48 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $199.53 / $302.00
| Professional | | $107.15 | $199.53 | $302.00 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $128.82 / $275.42
| Professional | | $33.11 | $128.82 | $275.42 |