- 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
- $271.67 / $285.70 / $396.15
| Professional | | $271.67 | $285.70 | $396.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.89 / $320.36 / $326.44
| Professional | | $261.89 | $320.36 | $326.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.18 / $439.73 / $4,334.00
| Professional | | $382.18 | $439.73 | $4,334.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.92 / $307.55 / $358.81
| Professional | | $281.92 | $307.55 | $358.81 |
- 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
- $320.36 / $342.04 / $419.21
| Professional | | $320.36 | $342.04 | $419.21 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.04 / $2,582.96 / $6,124.00
| Professional | | $286.04 | $2,582.96 | $6,124.00 |