- 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
- $552.22 / $632.19 / $1,103.64
| Professional | | $552.22 | $632.19 | $1,103.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $560.15 / $728.00 / $873.60
| Professional | | $560.15 | $728.00 | $873.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $802.79 / $915.74 / $3,935.00
| Professional | | $802.79 | $915.74 | $3,935.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $640.64 / $698.88 / $815.36
| Professional | | $640.64 | $698.88 | $815.36 |
- 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
- $594.04 / $728.00 / $935.63
| Professional | | $594.04 | $728.00 | $935.63 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $664.04 / $2,575.00 / $6,124.00
| Professional | | $664.04 | $2,575.00 | $6,124.00 |