- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $27.54 / $31.62 / $37.15
| Facility | 26 | $27.54 | $31.62 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $89.13 / $398.11
| Professional | | $60.26 | $89.13 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $93.33 / $181.97
| Professional | | $50.12 | $93.33 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $125.89 / $131.83
| Professional | | $77.62 | $125.89 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $91.20 / $107.15
| Professional | | $83.18 | $91.20 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.90 / $33.88 / $39.81
| Professional | 26 | $30.90 | $33.88 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $97.72 / $144.54
| Professional | | $74.13 | $97.72 | $144.54 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $120.23 / $194.98
| Professional | | $75.86 | $120.23 | $194.98 |