- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.50 / $56.97 / $244.00
| Professional | | $48.50 | $56.97 | $244.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.32 / $34.14 / $157.09
| Professional | 26 | $28.32 | $34.14 | $157.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.55 / $62.24 / $62.24
| Professional | | $48.55 | $62.24 | $62.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.21 / $34.14 / $53.92
| Professional | 26 | $29.21 | $34.14 | $53.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.82 / $38.63 / $77.58
| Professional | | $29.82 | $38.63 | $77.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.71 / $44.84 / $46.95
| Professional | 26 | $41.71 | $44.84 | $46.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.77 / $59.75 / $69.70
| Professional | | $54.77 | $59.75 | $69.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.04 / $32.77 / $38.22
| Professional | 26 | $30.04 | $32.77 | $38.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.79 / $62.24 / $77.64
| Professional | | $50.79 | $62.24 | $77.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.86 / $34.14 / $45.09
| Professional | 26 | $27.86 | $34.14 | $45.09 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $59.04 / $338.57
| Professional | | $29.27 | $59.04 | $338.57 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $4.63 / $24.74 / $54.44
| Professional | 26 | $4.63 | $24.74 | $54.44 |