- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.95 / $56.68 / $142.10
| Facility | | $5.95 | $56.68 | $142.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.16 / $5.35 / $7.21
| Professional | | $5.16 | $5.35 | $7.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.71 / $7.21 / $7.21
| Professional | | $4.71 | $7.21 | $7.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.76 / $12.87 / $15.06
| Professional | | $9.76 | $12.87 | $15.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.01 / $7.21 / $9.02
| Professional | | $6.01 | $7.21 | $9.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.52 / $7.21 / $11.66
| Professional | | $2.52 | $7.21 | $11.66 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.01 / $10.81 / $15.08
| Professional | | $6.01 | $10.81 | $15.08 |