- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.80 / $12.96 / $106.40
| Facility | | $10.80 | $12.96 | $106.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.30 / $15.30 / $15.30
| Professional | | $15.30 | $15.30 | $15.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.40 / $15.71 / $15.71
| Professional | | $10.40 | $15.71 | $15.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.61 / $24.55 / $28.73
| Professional | | $18.61 | $24.55 | $28.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.09 / $15.71 / $19.64
| Professional | | $13.09 | $15.71 | $19.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.50 / $15.71 / $22.19
| Professional | | $5.50 | $15.71 | $22.19 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.66 / $20.77 / $29.45
| Professional | | $14.66 | $20.77 | $29.45 |