- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,747.00 / $2,747.00 / $2,747.00
| Facility | | $2,747.00 | $2,747.00 | $2,747.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.27 / $350.97 / $431.38
| Professional | | $319.27 | $350.97 | $431.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.89 / $569.30 / $683.18
| Professional | | $434.89 | $569.30 | $683.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.94 / $596.52 / $2,077.00
| Professional | | $530.94 | $596.52 | $2,077.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.17 / $514.96 / $592.09
| Professional | | $453.17 | $514.96 | $592.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,078.00 / $1,078.00 / $1,078.00
| Facility | | $1,078.00 | $1,078.00 | $1,078.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.39 / $569.30 / $629.00
| Professional | | $376.39 | $569.30 | $629.00 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.66 / $435.05 / $592.63
| Professional | | $74.66 | $435.05 | $592.63 |