- 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
- $338.47 / $437.77 / $605.70
| Professional | | $338.47 | $437.77 | $605.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.48 / $643.98 / $772.77
| Professional | | $525.48 | $643.98 | $772.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $613.65 / $713.86 / $871.38
| Professional | | $613.65 | $713.86 | $871.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.20 / $538.62 / $643.98
| Professional | | $423.20 | $538.62 | $643.98 |
- 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
- $586.80 / $643.98 / $830.93
| Professional | | $586.80 | $643.98 | $830.93 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $454.10 / $2,000.00 / $5,304.00
| Professional | | $454.10 | $2,000.00 | $5,304.00 |