- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.21 / $71.84 / $108.36
| Facility | | $9.21 | $71.84 | $108.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.58 / $9.65 / $15.32
| Professional | | $9.58 | $9.65 | $15.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.83 / $13.39 / $13.39
| Professional | | $8.83 | $13.39 | $13.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.14 / $23.93 / $28.03
| Professional | | $18.14 | $23.93 | $28.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.16 / $13.39 / $16.73
| Professional | | $11.16 | $13.39 | $16.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.69 / $13.39 / $21.66
| Professional | | $4.69 | $13.39 | $21.66 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.50 / $20.28 / $28.08
| Professional | | $12.50 | $20.28 | $28.08 |