- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $38.51 / $43.64 / $51.34
| Facility | 26 | $38.51 | $43.64 | $51.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.28 / $350.81 / $512.62
| Professional | | $211.28 | $350.81 | $512.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.22 / $265.22 / $508.33
| Professional | | $265.22 | $265.22 | $508.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.25 / $399.85 / $445.22
| Professional | | $52.25 | $399.85 | $445.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.58 / $367.18 / $382.48
| Professional | | $336.58 | $367.18 | $382.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.83 / $45.64 / $47.54
| Professional | 26 | $41.83 | $45.64 | $47.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.22 / $413.07 / $546.29
| Professional | | $390.22 | $413.07 | $546.29 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.97 / $473.46 / $856.27
| Professional | | $345.97 | $473.46 | $856.27 |