- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.93 / $23.17 / $95.06
| Facility | | $15.93 | $23.17 | $95.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.55 / $19.30 / $26.51
| Professional | | $16.55 | $19.30 | $26.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.17 / $23.17 / $23.17
| Professional | | $23.17 | $23.17 | $23.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.75 / $34.93 / $43.66
| Professional | | $31.75 | $34.93 | $43.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.30 / $23.17 / $28.97
| Professional | | $19.30 | $23.17 | $28.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.11 / $23.17 / $35.71
| Professional | | $8.11 | $23.17 | $35.71 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.52 / $27.96 / $61.40
| Professional | | $13.52 | $27.96 | $61.40 |