- 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
- $434.01 / $525.85 / $747.73
| Professional | | $434.01 | $525.85 | $747.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $459.98 / $592.80 / $711.38
| Professional | | $459.98 | $592.80 | $711.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $859.18 / $988.56 / $1,212.25
| Professional | | $859.18 | $988.56 | $1,212.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $521.67 / $569.10 / $663.95
| Professional | | $521.67 | $569.10 | $663.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,689.00 / $1,689.00 / $1,689.00
| Facility | | $1,689.00 | $1,689.00 | $1,689.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.74 / $592.80 / $755.76
| Professional | | $483.74 | $592.80 | $755.76 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $560.38 / $2,500.00 / $6,063.00
| Professional | | $560.38 | $2,500.00 | $6,063.00 |