- 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
- $274.62 / $345.22 / $475.77
| Professional | | $274.62 | $345.22 | $475.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.65 / $440.21 / $491.70
| Professional | | $355.65 | $440.21 | $491.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $463.32 / $544.49 / $612.91
| Professional | | $463.32 | $544.49 | $612.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.00 / $432.70 / $550.70
| Professional | | $326.00 | $432.70 | $550.70 |
- 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
- $401.23 / $491.70 / $637.22
| Professional | | $401.23 | $491.70 | $637.22 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.12 / $1,958.52 / $5,287.00
| Professional | | $352.12 | $1,958.52 | $5,287.00 |