- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,324.03 / $2,747.00 / $4,456.00
| Facility | | $1,324.03 | $2,747.00 | $4,456.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.29 / $326.29 / $442.61
| Professional | | $326.29 | $326.29 | $442.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.24 / $586.79 / $704.15
| Professional | | $460.24 | $586.79 | $704.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.74 / $610.16 / $685.75
| Professional | | $529.74 | $610.16 | $685.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.65 / $506.79 / $586.79
| Professional | | $371.65 | $506.79 | $586.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $2,912.00 / $2,912.00
| Facility | | $2,912.00 | $2,912.00 | $2,912.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.64 / $586.79 / $709.77
| Professional | | $435.64 | $586.79 | $709.77 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.60 / $2,500.00 / $6,063.00
| Professional | | $402.60 | $2,500.00 | $6,063.00 |