- 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
- $551.41 / $551.41 / $551.41
| Professional | | $551.41 | $551.41 | $551.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.55 / $622.17 / $746.61
| Professional | | $537.55 | $622.17 | $746.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $641.39 / $731.63 / $4,765.00
| Professional | | $641.39 | $731.63 | $4,765.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $547.51 / $597.29 / $696.84
| Professional | | $547.51 | $597.29 | $696.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $2,155.00 / $2,155.00
| Facility | | $2,155.00 | $2,155.00 | $2,155.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.03 / $605.41 / $799.05
| Professional | | $461.03 | $605.41 | $799.05 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.96 / $2,582.96 / $6,124.00
| Professional | | $513.96 | $2,582.96 | $6,124.00 |