- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,635.55 / $2,747.00 / $5,484.00
| Facility | | $1,635.55 | $2,747.00 | $5,484.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.12 / $530.12 / $759.16
| Professional | | $530.12 | $530.12 | $759.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.84 / $584.01 / $700.82
| Professional | | $458.84 | $584.01 | $700.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $618.35 / $694.73 / $2,077.00
| Professional | | $618.35 | $694.73 | $2,077.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.92 / $560.65 / $654.09
| Professional | | $513.92 | $560.65 | $654.09 |
- 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
- $476.55 / $584.01 / $724.64
| Professional | | $476.55 | $584.01 | $724.64 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $566.72 / $3,191.04 / $8,000.00
| Professional | | $566.72 | $3,191.04 | $8,000.00 |