- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.31 / $96.22 / $135.38
| Professional | | $65.31 | $96.22 | $135.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.54 / $34.82 / $57.17
| Professional | 26 | $31.54 | $34.82 | $57.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.42 / $107.34 / $108.36
| Professional | | $88.42 | $107.34 | $108.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.25 / $45.79 / $48.92
| Professional | 26 | $37.25 | $45.79 | $48.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.24 / $77.34 / $108.60
| Professional | | $43.24 | $77.34 | $108.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.30 / $48.48 / $49.70
| Professional | 26 | $46.30 | $48.48 | $49.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.36 / $104.03 / $121.37
| Professional | | $95.36 | $104.03 | $121.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.17 / $43.82 / $51.13
| Professional | 26 | $40.17 | $43.82 | $51.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.37 / $108.28 / $142.52
| Professional | | $86.37 | $108.28 | $142.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.25 / $39.44 / $60.77
| Professional | 26 | $37.25 | $39.44 | $60.77 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.42 / $97.65 / $121.20
| Professional | | $68.42 | $97.65 | $121.20 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.71 / $44.10 / $49.09
| Professional | 26 | $27.71 | $44.10 | $49.09 |