- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.08 / $64.00 / $90.90
| Facility | | $9.08 | $64.00 | $90.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.18 / $8.52 / $12.62
| Professional | | $7.18 | $8.52 | $12.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.66 / $7.66 / $7.66
| Professional | | $7.66 | $7.66 | $7.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.79 / $20.83 / $24.39
| Professional | | $15.79 | $20.83 | $24.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.71 / $11.65 / $14.57
| Professional | | $9.71 | $11.65 | $14.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.08 / $11.65 / $18.84
| Professional | | $4.08 | $11.65 | $18.84 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.71 / $14.92 / $19.29
| Professional | | $9.71 | $14.92 | $19.29 |