- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.83 / $4.34 / $5.57
| Facility | | $3.83 | $4.34 | $5.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.73 / $5.57 / $5.57
| Professional | | $3.73 | $5.57 | $5.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.54 / $9.94 / $11.62
| Professional | | $7.54 | $9.94 | $11.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.63 / $5.57 / $6.96
| Professional | | $4.63 | $5.57 | $6.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.95 / $5.57 / $9.01
| Professional | | $1.95 | $5.57 | $9.01 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.20 / $8.42 / $11.66
| Professional | | $5.20 | $8.42 | $11.66 |