- 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
- $476.50 / $476.50 / $476.50
| Professional | | $476.50 | $476.50 | $476.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.90 / $531.90 / $609.17
| Professional | | $531.90 | $531.90 | $609.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.63 / $775.06 / $7,637.00
| Professional | | $673.63 | $775.06 | $7,637.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.07 / $510.62 / $595.73
| Professional | | $468.07 | $510.62 | $595.73 |
- 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
- $434.03 / $543.13 / $704.94
| Professional | | $434.03 | $543.13 | $704.94 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $585.53 / $2,040.00 / $5,304.00
| Professional | | $585.53 | $2,040.00 | $5,304.00 |