- 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
- $241.19 / $291.57 / $364.50
| Professional | | $241.19 | $291.57 | $364.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.84 / $533.91 / $640.70
| Professional | | $416.84 | $533.91 | $640.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.10 / $508.59 / $668.47
| Professional | | $430.10 | $508.59 | $668.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.89 / $452.76 / $533.91
| Professional | | $305.89 | $452.76 | $533.91 |
- 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
- $403.66 / $533.91 / $702.92
| Professional | | $403.66 | $533.91 | $702.92 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.88 / $2,500.00 / $6,063.00
| Professional | | $377.88 | $2,500.00 | $6,063.00 |