- 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
- $418.05 / $551.27 / $580.87
| Professional | | $418.05 | $551.27 | $580.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $590.30 / $756.39 / $756.39
| Professional | | $590.30 | $756.39 | $756.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $793.00 / $912.42 / $6,874.20
| Professional | | $793.00 | $912.42 | $6,874.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $665.62 / $726.13 / $847.15
| Professional | | $665.62 | $726.13 | $847.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $3,028.00 / $3,028.00
| Facility | | $3,028.00 | $3,028.00 | $3,028.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $665.36 / $756.39 / $945.50
| Professional | | $665.36 | $756.39 | $945.50 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $623.91 / $3,191.04 / $8,007.00
| Professional | | $623.91 | $3,191.04 | $8,007.00 |