- 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
- $203.68 / $282.63 / $398.46
| Professional | | $203.68 | $282.63 | $398.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.29 / $427.14 / $429.24
| Professional | | $322.29 | $427.14 | $429.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.05 / $486.80 / $6,873.30
| Professional | | $400.05 | $486.80 | $6,873.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.08 / $375.88 / $427.14
| Professional | | $290.08 | $375.88 | $427.14 |
- 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
- $348.54 / $427.14 / $578.24
| Professional | | $348.54 | $427.14 | $578.24 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.73 / $2,500.00 / $6,063.00
| Professional | | $331.73 | $2,500.00 | $6,063.00 |