- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.82 / $88.80 / $284.39
| Facility | | $10.82 | $88.80 | $284.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.68 / $12.73 / $15.88
| Professional | | $8.68 | $12.73 | $15.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.44 / $8.44 / $8.44
| Professional | | $8.44 | $8.44 | $8.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.39 / $22.94 / $26.81
| Professional | | $17.39 | $22.94 | $26.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.57 / $13.88 / $17.36
| Professional | | $11.57 | $13.88 | $17.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.86 / $13.88 / $20.73
| Professional | | $4.86 | $13.88 | $20.73 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.67 / $18.45 / $21.21
| Professional | | $15.67 | $18.45 | $21.21 |