- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.26 / $3.69 / $4.74
| Facility | | $3.26 | $3.69 | $4.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.61 / $4.61 / $4.61
| Professional | | $4.61 | $4.61 | $4.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.14 / $4.74 / $4.74
| Professional | | $3.14 | $4.74 | $4.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.41 / $8.44 / $9.92
| Professional | | $6.41 | $8.44 | $9.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.95 / $4.74 / $5.93
| Professional | | $3.95 | $4.74 | $5.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.66 / $4.74 / $7.67
| Professional | | $1.66 | $4.74 | $7.67 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.42 / $7.16 / $9.92
| Professional | | $4.42 | $7.16 | $9.92 |