- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.09 / $13.31 / $171.71
| Facility | | $11.09 | $13.31 | $171.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.70 / $11.96 / $15.54
| Professional | | $11.70 | $11.96 | $15.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.60 / $16.13 / $16.13
| Professional | | $10.60 | $16.13 | $16.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.86 / $28.84 / $33.74
| Professional | | $21.86 | $28.84 | $33.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.44 / $16.13 / $20.16
| Professional | | $13.44 | $16.13 | $20.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.64 / $16.13 / $26.08
| Professional | | $5.64 | $16.13 | $26.08 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.05 / $24.40 / $33.79
| Professional | | $15.05 | $24.40 | $33.79 |