- 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
- $422.94 / $422.94 / $422.94
| Professional | | $422.94 | $422.94 | $422.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $451.03 / $587.29 / $704.75
| Professional | | $451.03 | $587.29 | $704.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.70 / $690.23 / $814.90
| Professional | | $630.70 | $690.23 | $814.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.80 / $563.79 / $657.76
| Professional | | $516.80 | $563.79 | $657.76 |
- 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
- $479.23 / $587.29 / $730.74
| Professional | | $479.23 | $587.29 | $730.74 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.54 / $2,582.96 / $6,124.00
| Professional | | $554.54 | $2,582.96 | $6,124.00 |