- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $27.70 / $31.40 / $38.47
| Facility | 26 | $27.70 | $31.40 | $38.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.04 / $74.87 / $113.25
| Professional | | $54.04 | $74.87 | $113.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.03 / $87.30 / $106.99
| Professional | | $79.03 | $87.30 | $106.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.67 / $64.63 / $113.44
| Professional | | $35.67 | $64.63 | $113.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.15 / $102.71 / $119.83
| Professional | | $94.15 | $102.71 | $119.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.86 / $36.94 / $43.09
| Professional | 26 | $33.86 | $36.94 | $43.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.72 / $105.11 / $138.81
| Professional | | $83.72 | $105.11 | $138.81 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.59 / $102.34 / $119.72
| Professional | | $67.59 | $102.34 | $119.72 |