- 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
- $630.23 / $630.23 / $630.23
| Professional | | $630.23 | $630.23 | $630.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $559.26 / $724.86 / $869.84
| Professional | | $559.26 | $724.86 | $869.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $837.92 / $917.02 / $1,082.64
| Professional | | $837.92 | $917.02 | $1,082.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $637.88 / $695.87 / $811.85
| Professional | | $637.88 | $695.87 | $811.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $2,155.00 / $2,155.00
| Facility | | $2,155.00 | $2,155.00 | $2,155.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $591.49 / $724.86 / $904.16
| Professional | | $591.49 | $724.86 | $904.16 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $689.24 / $2,582.96 / $6,124.00
| Professional | | $689.24 | $2,582.96 | $6,124.00 |