- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.88 / $2,747.00 / $3,883.00
| Facility | | $1,157.88 | $2,747.00 | $3,883.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.25 / $338.30 / $360.83
| Professional | | $310.25 | $338.30 | $360.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.99 / $605.53 / $726.63
| Professional | | $462.99 | $605.53 | $726.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.08 / $596.67 / $2,077.00
| Professional | | $531.08 | $596.67 | $2,077.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.40 / $539.09 / $629.75
| Professional | | $474.40 | $539.09 | $629.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,078.00 / $1,078.00 / $1,078.00
| Facility | | $1,078.00 | $1,078.00 | $1,078.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $395.11 / $605.53 / $635.92
| Professional | | $395.11 | $605.53 | $635.92 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.31 / $434.88 / $546.51
| Professional | | $68.31 | $434.88 | $546.51 |