- 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
- $162.13 / $212.03 / $238.28
| Professional | | $162.13 | $212.03 | $238.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.89 / $451.62 / $562.73
| Professional | | $319.89 | $451.62 | $562.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.39 / $378.86 / $511.09
| Professional | | $320.39 | $378.86 | $511.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.86 / $397.66 / $468.94
| Professional | | $254.86 | $397.66 | $468.94 |
- 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
- $319.49 / $467.89 / $524.34
| Professional | | $319.49 | $467.89 | $524.34 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.26 / $2,500.00 / $6,063.00
| Professional | | $271.26 | $2,500.00 | $6,063.00 |