- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.83 / $5.48 / $7.03
| Facility | | $4.83 | $5.48 | $7.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.71 / $7.03 / $7.03
| Professional | | $4.71 | $7.03 | $7.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.52 / $12.55 / $14.72
| Professional | | $9.52 | $12.55 | $14.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.86 / $7.03 / $8.19
| Professional | | $5.86 | $7.03 | $8.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.46 / $7.03 / $11.37
| Professional | | $2.46 | $7.03 | $11.37 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.56 / $10.65 / $14.74
| Professional | | $6.56 | $10.65 | $14.74 |