- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,747.00 / $8,210.00 / $10,007.00
| Facility | | $2,747.00 | $8,210.00 | $10,007.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,278.41 / $1,278.41 / $1,403.82
| Professional | | $1,278.41 | $1,278.41 | $1,403.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,521.78 / $1,668.22 / $2,152.39
| Professional | | $1,521.78 | $1,668.22 | $2,152.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,511.67 / $1,723.34 / $21,669.00
| Professional | | $1,511.67 | $1,723.34 | $21,669.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,339.16 / $1,460.90 / $1,704.39
| Professional | | $1,339.16 | $1,460.90 | $1,704.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,960.00 / $3,960.00 / $3,960.00
| Facility | | $3,960.00 | $3,960.00 | $3,960.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,241.77 / $1,584.53 / $2,055.35
| Professional | | $1,241.77 | $1,584.53 | $2,055.35 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,132.71 / $1,550.33 / $12,600.00
| Professional | | $1,132.71 | $1,550.33 | $12,600.00 |