- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.27 / $5.13 / $6.17
| Facility | | $4.27 | $5.13 | $6.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $5.01 / $6.03
| Professional | | $3.98 | $5.01 | $6.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.50 / $5.50 / $6.17
| Professional | | $5.50 | $5.50 | $6.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $15.14 / $16.98
| Professional | | $12.02 | $15.14 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.13 / $6.17 / $7.76
| Professional | | $5.13 | $6.17 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.19 / $7.76 / $13.49
| Professional | | $2.19 | $7.76 | $13.49 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.75 / $11.48 / $17.38
| Professional | | $5.75 | $11.48 | $17.38 |