- 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
- $554.35 / $595.50 / $913.56
| Professional | | $554.35 | $595.50 | $913.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $585.25 / $731.76 / $731.76
| Professional | | $585.25 | $731.76 | $731.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $830.42 / $955.47 / $4,334.00
| Professional | | $830.42 | $955.47 | $4,334.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $643.95 / $702.49 / $819.57
| Professional | | $643.95 | $702.49 | $819.57 |
- 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
- $597.12 / $731.76 / $945.18
| Professional | | $597.12 | $731.76 | $945.18 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $700.37 / $2,582.96 / $6,124.00
| Professional | | $700.37 | $2,582.96 | $6,124.00 |