- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.23 / $38.58 / $67.15
| Facility | | $2.23 | $38.58 | $67.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.33 / $2.52 / $8.50
| Professional | | $2.33 | $2.52 | $8.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.16 / $3.24 / $3.24
| Professional | | $2.16 | $3.24 | $3.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.38 / $5.79 / $6.79
| Professional | | $4.38 | $5.79 | $6.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.70 / $3.24 / $4.05
| Professional | | $2.70 | $3.24 | $4.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.12 / $3.24 / $5.24
| Professional | | $1.12 | $3.24 | $5.24 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.70 / $4.86 / $6.79
| Professional | | $2.70 | $4.86 | $6.79 |