- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,890.45 / $3,890.45
| Facility | | $1,513.56 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $549.54 / $2,754.23
| Professional | | $489.78 | $549.54 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $616.60 / $741.31
| Professional | | $524.81 | $616.60 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $794.33 / $7,762.47
| Professional | | $676.08 | $794.33 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $602.56 / $741.31
| Professional | | $524.81 | $602.56 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $1,995.26 / $1,995.26
| Facility | | $1,995.26 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $549.54 / $851.14
| Professional | | $416.87 | $549.54 | $851.14 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $2,089.30 / $5,370.32
| Professional | | $630.96 | $2,089.30 | $5,370.32 |