- 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
- $667.59 / $667.59 / $1,057.68
| Professional | | $667.59 | $667.59 | $1,057.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $641.80 / $832.88 / $999.45
| Professional | | $641.80 | $832.88 | $999.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $863.81 / $970.52 / $5,851.00
| Professional | | $863.81 | $970.52 | $5,851.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $732.93 / $799.56 / $932.82
| Professional | | $732.93 | $799.56 | $932.82 |
- 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
- $650.75 / $832.88 / $1,041.98
| Professional | | $650.75 | $832.88 | $1,041.98 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.98 / $3,191.04 / $8,000.00
| Professional | | $759.98 | $3,191.04 | $8,000.00 |