- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.46 / $50.39 / $61.75
| Facility | | $44.46 | $50.39 | $61.75 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $41.28 / $46.79 / $57.34
| Facility | 26 | $41.28 | $46.79 | $57.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.66 / $77.50 / $77.50
| Professional | | $15.66 | $77.50 | $77.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.66 / $53.60 / $71.63
| Professional | 26 | $15.66 | $53.60 | $71.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.75 / $61.75 / $61.75
| Professional | | $61.75 | $61.75 | $61.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.34 / $57.34 / $57.34
| Professional | 26 | $57.34 | $57.34 | $57.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.89 / $58.15 / $60.10
| Professional | | $44.89 | $58.15 | $60.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $48.08 / $50.35 / $51.60
| Professional | 26 | $48.08 | $50.35 | $51.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.34 / $59.28 / $69.16
| Professional | | $54.34 | $59.28 | $69.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.46 / $55.04 / $64.22
| Professional | 26 | $50.46 | $55.04 | $64.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.11 / $29.54 / $61.75
| Professional | | $27.11 | $29.54 | $61.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.10 / $29.52 / $57.34
| Professional | 26 | $27.10 | $29.52 | $57.34 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.08 / $51.08 / $51.08
| Professional | | $51.08 | $51.08 | $51.08 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.11 / $24.76 / $47.68
| Professional | 26 | $21.11 | $24.76 | $47.68 |