- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.08 / $14.12 / $261.77
| Facility | | $4.08 | $14.12 | $261.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.96 / $1.06 / $1.06
| Professional | | $0.96 | $1.06 | $1.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.00 / $85.00 / $85.00
| Facility | | $85.00 | $85.00 | $85.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.96 / $0.96 / $1.44
| Professional | | $0.96 | $0.96 | $1.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.75 / $1.83 / $1.83
| Professional | | $1.75 | $1.83 | $1.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.05 / $1.14 / $1.34
| Professional | | $1.05 | $1.14 | $1.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.61 / $0.96 / $1.44
| Professional | | $0.61 | $0.96 | $1.44 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.93 / $1.49 / $1.80
| Professional | | $0.93 | $1.49 | $1.80 |