- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $4,466.84 / $4,466.84
| Facility | | $1,778.28 | $4,466.84 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $457.09 / $616.60
| Professional | | $398.11 | $457.09 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $524.81 / $549.54
| Professional | | $436.52 | $524.81 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $3,981.07 / $5,623.41
| Professional | | $660.69 | $3,981.07 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $512.86 / $645.65
| Professional | | $478.63 | $512.86 | $645.65 |
- 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
- $446.68 / $549.54 / $707.95
| Professional | | $446.68 | $549.54 | $707.95 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $5,128.61 / $6,456.54
| Professional | | $537.03 | $5,128.61 | $6,456.54 |