- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $2,818.38 / $3,890.45
| Facility | | $741.31 | $2,818.38 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $537.03 / $2,754.23
| Professional | | $446.68 | $537.03 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $588.84 / $707.95
| Professional | | $501.19 | $588.84 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $794.33 / $7,762.47
| Professional | | $676.08 | $794.33 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $575.44 / $724.44
| Professional | | $512.86 | $575.44 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $1,995.26 / $1,995.26
| Facility | | $1,995.26 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $537.03 / $812.83
| Professional | | $398.11 | $537.03 | $812.83 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $2,089.30 / $5,370.32
| Professional | | $588.84 | $2,089.30 | $5,370.32 |