- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.84 / $68.70 / $162.44
| Professional | | $66.84 | $68.70 | $162.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.38 / $41.88 / $54.46
| Professional | 26 | $36.38 | $41.88 | $54.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.67 / $75.31 / $109.76
| Professional | | $52.67 | $75.31 | $109.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.60 / $39.29 / $63.32
| Professional | 26 | $30.60 | $39.29 | $63.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.52 / $46.96 / $94.93
| Professional | | $38.52 | $46.96 | $94.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $49.10 / $51.41 / $53.54
| Professional | 26 | $49.10 | $51.41 | $53.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.63 / $87.80 / $102.44
| Professional | | $74.63 | $87.80 | $102.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.78 / $42.10 / $49.11
| Professional | 26 | $35.78 | $42.10 | $49.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.12 / $90.70 / $109.47
| Professional | | $64.12 | $90.70 | $109.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.78 / $43.85 / $59.58
| Professional | 26 | $35.78 | $43.85 | $59.58 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.03 / $91.25 / $151.08
| Professional | | $56.03 | $91.25 | $151.08 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.07 / $44.08 / $79.42
| Professional | 26 | $27.07 | $44.08 | $79.42 |