- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.16 / $75.26 / $135.80
| Facility | | $7.16 | $75.26 | $135.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.60 / $6.51 / $7.81
| Professional | | $5.60 | $6.51 | $7.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.09 / $5.09 / $5.09
| Professional | | $5.09 | $5.09 | $5.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.60 / $13.99 / $16.38
| Professional | | $10.60 | $13.99 | $16.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.51 / $7.81 / $9.77
| Professional | | $6.51 | $7.81 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.73 / $7.81 / $12.64
| Professional | | $2.73 | $7.81 | $12.64 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.56 / $11.83 / $16.38
| Professional | | $9.56 | $11.83 | $16.38 |