- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.40 / $13.68 / $70.43
| Facility | | $11.40 | $13.68 | $70.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.74 / $10.84 / $69.00
| Professional | | $10.74 | $10.84 | $69.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.42 / $16.57 / $16.57
| Professional | | $9.42 | $16.57 | $16.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.51 / $25.73 / $30.11
| Professional | | $19.51 | $25.73 | $30.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.82 / $16.57 / $20.73
| Professional | | $13.82 | $16.57 | $20.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.80 / $16.57 / $23.27
| Professional | | $5.80 | $16.57 | $23.27 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.48 / $21.79 / $31.01
| Professional | | $15.48 | $21.79 | $31.01 |