- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.21 / $38.64 / $50.41
| Professional | | $37.21 | $38.64 | $50.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.59 / $23.71 / $25.09
| Professional | 26 | $20.59 | $23.71 | $25.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.60 / $54.55 / $67.93
| Professional | | $32.60 | $54.55 | $67.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.36 / $24.82 / $34.47
| Professional | 26 | $17.36 | $24.82 | $34.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.43 / $37.58 / $70.36
| Professional | | $28.43 | $37.58 | $70.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.45 / $31.88 / $32.68
| Professional | 26 | $30.45 | $31.88 | $32.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.55 / $64.18 / $74.87
| Professional | | $54.55 | $64.18 | $74.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.62 / $24.26 / $28.31
| Professional | 26 | $20.62 | $24.26 | $28.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.53 / $66.84 / $94.62
| Professional | | $45.53 | $66.84 | $94.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.62 / $25.28 / $60.32
| Professional | 26 | $20.62 | $25.28 | $60.32 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.07 / $59.84 / $86.34
| Professional | | $40.07 | $59.84 | $86.34 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.46 / $24.89 / $45.08
| Professional | 26 | $18.46 | $24.89 | $45.08 |