- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $9,233.00 / $12,235.00
| Facility | | $1,200.00 | $9,233.00 | $12,235.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,650.00 / $5,521.00 / $12,235.00
| Facility | | $1,650.00 | $5,521.00 | $12,235.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $374.31 / $863.00 / $941.00
| Facility | | $374.31 | $863.00 | $941.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.00 / $275.00 / $25,886.78
| Facility | | $110.00 | $275.00 | $25,886.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $1,666.00 / $12,897.00
| Facility | | $1,200.00 | $1,666.00 | $12,897.00 |
University Health Alliance - Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,280.00 / $3,772.00 / $14,755.00
| Facility | | $1,280.00 | $3,772.00 | $14,755.00 |