- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $75.86 / $107.15
| Professional | | $66.07 | $75.86 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.02 / $43.65 / $70.79
| Professional | 26 | $38.02 | $43.65 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $83.18 / $125.89
| Professional | | $57.54 | $83.18 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.02 / $50.12 / $72.44
| Professional | 26 | $38.02 | $50.12 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $53.70 / $102.33
| Professional | | $41.69 | $53.70 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.23 / $58.88 / $61.66
| Professional | 26 | $56.23 | $58.88 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $97.72 / $114.82
| Professional | | $83.18 | $97.72 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.66 / $50.12 / $58.88
| Professional | 26 | $42.66 | $50.12 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $93.33 / $120.23
| Professional | | $74.13 | $93.33 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.69 / $51.29 / $69.18
| Professional | 26 | $41.69 | $51.29 | $69.18 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $100.00 / $162.18
| Professional | | $74.13 | $100.00 | $162.18 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.02 / $51.29 / $91.20
| Professional | 26 | $38.02 | $51.29 | $91.20 |