- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $24.44 / $27.70 / $32.59
| Facility | 26 | $24.44 | $27.70 | $32.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.15 / $56.00 / $103.40
| Professional | | $41.15 | $56.00 | $103.40 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $28.28 / $28.28 / $28.28
| Facility | 26 | $28.28 | $28.28 | $28.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.78 / $75.05 / $93.85
| Professional | | $61.78 | $75.05 | $93.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.40 / $76.25 / $91.50
| Professional | | $30.40 | $76.25 | $91.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.69 / $76.02 / $88.69
| Professional | | $69.69 | $76.02 | $88.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.55 / $28.97 / $33.79
| Professional | 26 | $26.55 | $28.97 | $33.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.89 / $85.52 / $98.31
| Professional | | $32.89 | $85.52 | $98.31 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.12 / $99.04 / $142.78
| Professional | | $64.12 | $99.04 | $142.78 |