- 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
- $539.04 / $579.80 / $579.80
| Professional | | $539.04 | $579.80 | $579.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.90 / $710.74 / $710.74
| Professional | | $561.90 | $710.74 | $710.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $819.09 / $942.44 / $6,874.20
| Professional | | $819.09 | $942.44 | $6,874.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $625.45 / $682.31 / $796.03
| Professional | | $625.45 | $682.31 | $796.03 |
- 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
- $706.53 / $710.74 / $911.63
| Professional | | $706.53 | $710.74 | $911.63 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $679.38 / $3,900.00 / $8,000.00
| Professional | | $679.38 | $3,900.00 | $8,000.00 |