- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,486.00 / $3,883.00 / $4,705.00
| Facility | | $1,486.00 | $3,883.00 | $4,705.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.15 / $266.02 / $324.97
| Professional | | $212.15 | $266.02 | $324.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.55 / $479.80 / $575.76
| Professional | | $414.55 | $479.80 | $575.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.99 / $441.06 / $3,857.00
| Professional | | $372.99 | $441.06 | $3,857.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.92 / $383.84 / $479.80
| Professional | | $259.92 | $383.84 | $479.80 |
- 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
- $343.81 / $461.86 / $612.32
| Professional | | $343.81 | $461.86 | $612.32 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.86 / $318.27 / $526.89
| Professional | | $65.86 | $318.27 | $526.89 |