- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.01 / $4.54 / $5.83
| Facility | | $4.01 | $4.54 | $5.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.93 / $5.83 / $5.83
| Professional | | $3.93 | $5.83 | $5.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.92 / $10.44 / $12.21
| Professional | | $7.92 | $10.44 | $12.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.86 / $5.83 / $7.29
| Professional | | $4.86 | $5.83 | $7.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.04 / $5.83 / $9.44
| Professional | | $2.04 | $5.83 | $9.44 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.44 / $8.83 / $12.22
| Professional | | $5.44 | $8.83 | $12.22 |