- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.04 / $26.04 / $26.04
| Professional | | $26.04 | $26.04 | $26.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.19 / $5.19 / $5.19
| Professional | 26 | $5.19 | $5.19 | $5.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.75 / $44.00 / $62.17
| Professional | | $26.75 | $44.00 | $62.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.13 / $10.02 / $11.20
| Professional | 26 | $9.13 | $10.02 | $11.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.42 / $35.89 / $61.24
| Professional | | $9.42 | $35.89 | $61.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.32 / $10.81 / $11.08
| Professional | 26 | $10.32 | $10.81 | $11.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.61 / $53.03 / $61.87
| Professional | | $48.61 | $53.03 | $61.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.76 / $9.55 / $11.14
| Professional | 26 | $8.76 | $9.55 | $11.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.30 / $59.66 / $66.40
| Professional | | $21.30 | $59.66 | $66.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $4.50 / $10.75 / $12.17
| Professional | 26 | $4.50 | $10.75 | $12.17 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.85 / $58.00 / $96.83
| Professional | | $35.85 | $58.00 | $96.83 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $11.89 / $19.46
| Professional | 26 | $7.94 | $11.89 | $19.46 |