- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.02 / $74.02 / $122.73
| Professional | | $74.02 | $74.02 | $122.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.75 / $24.01 / $28.22
| Professional | 26 | $22.75 | $24.01 | $28.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.33 / $92.31 / $110.78
| Professional | | $75.33 | $92.31 | $110.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.59 / $24.01 / $28.82
| Professional | 26 | $19.59 | $24.01 | $28.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.92 / $69.89 / $97.59
| Professional | | $22.92 | $69.89 | $97.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.55 / $25.71 / $26.35
| Professional | 26 | $24.55 | $25.71 | $26.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.23 / $88.62 / $103.39
| Professional | | $81.23 | $88.62 | $103.39 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.13 / $23.05 / $26.89
| Professional | 26 | $21.13 | $23.05 | $26.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.54 / $92.01 / $131.36
| Professional | | $35.54 | $92.01 | $131.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.59 / $24.01 / $32.27
| Professional | 26 | $19.59 | $24.01 | $32.27 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.54 / $85.20 / $109.02
| Professional | | $61.54 | $85.20 | $109.02 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.48 / $23.58 / $25.64
| Professional | 26 | $14.48 | $23.58 | $25.64 |