- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.72 / $4.47 / $5.37
| Facility | | $3.72 | $4.47 | $5.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $3.02 / $3.98
| Professional | | $2.00 | $3.02 | $3.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.51 / $2.51 / $5.37
| Professional | | $2.51 | $2.51 | $5.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.62 / $7.24 / $7.94
| Professional | | $5.62 | $7.24 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.47 / $5.37 / $6.76
| Professional | | $4.47 | $5.37 | $6.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.86 / $5.37 / $6.76
| Professional | | $1.86 | $5.37 | $6.76 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.79 / $6.03 / $8.32
| Professional | | $4.79 | $6.03 | $8.32 |