- 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
- $345.35 / $370.01 / $1,387.90
| Professional | | $345.35 | $370.01 | $1,387.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $443.08 / $443.08 / $468.53
| Professional | | $443.08 | $443.08 | $468.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.10 / $608.77 / $4,863.00
| Professional | | $529.10 | $608.77 | $4,863.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.91 / $425.35 / $496.24
| Professional | | $389.91 | $425.35 | $496.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $2,155.00 / $2,155.00
| Facility | | $2,155.00 | $2,155.00 | $2,155.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.55 / $443.08 / $586.62
| Professional | | $361.55 | $443.08 | $586.62 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $472.63 / $2,582.96 / $6,124.00
| Professional | | $472.63 | $2,582.96 | $6,124.00 |