- 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
- $564.65 / $564.65 / $564.65
| Professional | | $564.65 | $564.65 | $564.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $576.72 / $750.29 / $900.35
| Professional | | $576.72 | $750.29 | $900.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $774.62 / $870.31 / $5,851.00
| Professional | | $774.62 | $870.31 | $5,851.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.25 / $720.28 / $840.32
| Professional | | $660.25 | $720.28 | $840.32 |
- 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
- $549.54 / $652.82 / $936.18
| Professional | | $549.54 | $652.82 | $936.18 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $536.39 / $2,575.00 / $6,124.00
| Professional | | $536.39 | $2,575.00 | $6,124.00 |