- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.07 / $38.85 / $53.68
| Professional | | $34.07 | $38.85 | $53.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.53 / $22.24 / $24.02
| Professional | 26 | $20.53 | $22.24 | $24.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.86 / $55.78 / $68.36
| Professional | | $33.86 | $55.78 | $68.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.07 / $25.14 / $36.22
| Professional | 26 | $18.07 | $25.14 | $36.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.49 / $37.14 / $67.48
| Professional | | $25.49 | $37.14 | $67.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.30 / $28.59 / $29.30
| Professional | 26 | $27.30 | $28.59 | $29.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.78 / $65.63 / $76.56
| Professional | | $55.78 | $65.63 | $76.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.86 / $25.72 / $30.00
| Professional | 26 | $21.86 | $25.72 | $30.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.78 / $68.36 / $98.38
| Professional | | $48.78 | $68.36 | $98.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.86 / $26.79 / $64.90
| Professional | 26 | $21.86 | $26.79 | $64.90 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.18 / $62.79 / $96.26
| Professional | | $42.18 | $62.79 | $96.26 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.37 / $25.34 / $49.00
| Professional | 26 | $18.37 | $25.34 | $49.00 |