- 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
- $521.08 / $521.08 / $521.08
| Professional | | $521.08 | $521.08 | $521.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.39 / $718.90 / $862.68
| Professional | | $554.39 | $718.90 | $862.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $745.37 / $837.44 / $5,851.00
| Professional | | $745.37 | $837.44 | $5,851.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $632.63 / $690.14 / $805.17
| Professional | | $632.63 | $690.14 | $805.17 |
- 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
- $559.15 / $718.90 / $896.78
| Professional | | $559.15 | $718.90 | $896.78 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $626.51 / $3,191.04 / $8,000.00
| Professional | | $626.51 | $3,191.04 | $8,000.00 |