- 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
- $471.45 / $471.45 / $471.45
| Professional | | $471.45 | $471.45 | $471.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $582.04 / $582.04 / $604.40
| Professional | | $582.04 | $582.04 | $604.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $708.95 / $818.04 / $926.63
| Professional | | $708.95 | $818.04 | $926.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.87 / $580.22 / $676.93
| Professional | | $531.87 | $580.22 | $676.93 |
- 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
- $493.19 / $605.87 / $779.91
| Professional | | $493.19 | $605.87 | $779.91 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $597.88 / $2,582.96 / $6,124.00
| Professional | | $597.88 | $2,582.96 | $6,124.00 |