- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $569.09 / $590.42 / $604.66
| Professional | | $569.09 | $590.42 | $604.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $628.37 / $628.37 / $725.77
| Professional | | $628.37 | $628.37 | $725.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $727.32 / $727.32 / $727.32
| Professional | | $727.32 | $727.32 | $727.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $5.00 / $670.00
| Professional | | $5.00 | $5.00 | $670.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $587.53 / $592.79 / $889.20
| Professional | | $587.53 | $592.79 | $889.20 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $615.79 / $754.68 / $1,046.43
| Professional | | $615.79 | $754.68 | $1,046.43 |