- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.46 / $382.69 / $594.15
| Facility | | $17.46 | $382.69 | $594.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.16 / $12.75 / $39.00
| Professional | | $0.16 | $12.75 | $39.00 |
- 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
- $0.15 / $0.15 / $0.17
| Professional | | $0.15 | $0.15 | $0.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.20 / $0.21 / $0.21
| Professional | | $0.20 | $0.21 | $0.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.17 / $0.18 / $0.21
| Professional | | $0.17 | $0.18 | $0.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.09 / $0.17 / $0.23
| Professional | | $0.09 | $0.17 | $0.23 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.14 / $0.17 / $0.23
| Professional | | $0.14 | $0.17 | $0.23 |