- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.62 / $244.71 / $392.73
| Professional | | $60.62 | $244.71 | $392.73 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $102.02 / $133.74 / $150.66
| Professional | 52 | $102.02 | $133.74 | $150.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.05 / $354.07 / $1,241.63
| Professional | | $246.05 | $354.07 | $1,241.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.88 / $329.27 / $370.67
| Professional | | $286.88 | $329.27 | $370.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.99 / $352.79 / $411.59
| Professional | | $293.99 | $352.79 | $411.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.00 / $298.88 / $478.95
| Professional | | $73.00 | $298.88 | $478.95 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.00 / $425.00 / $580.00
| Professional | | $350.00 | $425.00 | $580.00 |