- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,635.55 / $2,747.00 / $5,484.00
| Facility | | $1,635.55 | $2,747.00 | $5,484.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.47 / $389.55 / $867.00
| Professional | | $378.47 | $389.55 | $867.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.87 / $428.11 / $452.91
| Professional | | $350.87 | $428.11 | $452.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $544.76 / $628.57 / $8,155.00
| Professional | | $544.76 | $628.57 | $8,155.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.74 / $410.99 / $479.49
| Professional | | $376.74 | $410.99 | $479.49 |
- 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
- $349.34 / $431.96 / $561.74
| Professional | | $349.34 | $431.96 | $561.74 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.92 / $3,900.00 / $8,000.00
| Professional | | $426.92 | $3,900.00 | $8,000.00 |