- 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
- $284.74 / $399.74 / $822.16
| Professional | | $284.74 | $399.74 | $822.16 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $254.18 / $254.18 / $254.18
| Professional | 50 | $254.18 | $254.18 | $254.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $539.74 / $624.70 / $749.64
| Professional | | $539.74 | $624.70 | $749.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.17 / $517.94 / $3,857.00
| Professional | | $438.17 | $517.94 | $3,857.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.59 / $499.76 / $624.70
| Professional | | $357.59 | $499.76 | $624.70 |
- 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
- $423.23 / $595.01 / $624.70
| Professional | | $423.23 | $595.01 | $624.70 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.19 / $2,500.00 / $6,063.00
| Professional | | $426.19 | $2,500.00 | $6,063.00 |