- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.72 / $9.88 / $11.62
| Facility | 26 | $8.72 | $9.88 | $11.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.01 / $33.40 / $61.44
| Professional | | $28.01 | $33.40 | $61.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.92 / $8.82 / $13.32
| Professional | 26 | $7.92 | $8.82 | $13.32 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.01 / $10.01 / $10.01
| Facility | 26 | $10.01 | $10.01 | $10.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $35.20 / $51.12
| Professional | | $29.51 | $35.20 | $51.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.88 / $10.38 / $12.92
| Professional | 26 | $9.88 | $10.38 | $12.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.24 / $32.26 / $53.36
| Professional | | $10.24 | $32.26 | $53.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.23 / $11.76 / $12.05
| Professional | 26 | $11.23 | $11.76 | $12.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.72 / $44.44 / $51.84
| Professional | | $40.72 | $44.44 | $51.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.47 / $10.33 / $12.05
| Professional | 26 | $9.47 | $10.33 | $12.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.29 / $49.99 / $56.33
| Professional | | $18.29 | $49.99 | $56.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.31 / $11.62 / $14.49
| Professional | 26 | $5.31 | $11.62 | $14.49 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.97 / $54.89 / $78.56
| Professional | | $33.97 | $54.89 | $78.56 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.59 / $12.98 / $22.08
| Professional | 26 | $8.59 | $12.98 | $22.08 |