- 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
- $278.99 / $412.18 / $537.88
| Professional | | $278.99 | $412.18 | $537.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.34 / $646.17 / $775.41
| Professional | | $504.34 | $646.17 | $775.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.35 / $606.13 / $805.68
| Professional | | $515.35 | $606.13 | $805.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.41 / $547.96 / $646.17
| Professional | | $372.41 | $547.96 | $646.17 |
- 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
- $508.20 / $646.17 / $832.40
| Professional | | $508.20 | $646.17 | $832.40 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $445.54 / $2,500.00 / $6,063.00
| Professional | | $445.54 | $2,500.00 | $6,063.00 |