- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.51 / $8.02 / $110.58
| Facility | | $5.51 | $8.02 | $110.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.68 / $8.02 / $9.17
| Professional | | $6.68 | $8.02 | $9.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.30 / $8.02 / $8.02
| Professional | | $5.30 | $8.02 | $8.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.84 / $14.29 / $16.79
| Professional | | $10.84 | $14.29 | $16.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.68 / $8.02 / $10.02
| Professional | | $6.68 | $8.02 | $10.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.81 / $8.02 / $12.95
| Professional | | $2.81 | $8.02 | $12.95 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.48 / $12.04 / $16.79
| Professional | | $7.48 | $12.04 | $16.79 |