- 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
- $423.77 / $614.63 / $820.38
| Professional | | $423.77 | $614.63 | $820.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $576.59 / $808.25 / $975.96
| Professional | | $576.59 | $808.25 | $975.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $811.79 / $959.94 / $1,161.39
| Professional | | $811.79 | $959.94 | $1,161.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $563.27 / $858.85 / $1,093.08
| Professional | | $563.27 | $858.85 | $1,093.08 |
- 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
- $796.39 / $975.96 / $1,174.46
| Professional | | $796.39 | $975.96 | $1,174.46 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $687.31 / $2,000.00 / $5,304.00
| Professional | | $687.31 | $2,000.00 | $5,304.00 |