- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.98 / $4.51 / $5.78
| Facility | | $3.98 | $4.51 | $5.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.53 / $5.78 / $5.78
| Professional | | $3.53 | $5.78 | $5.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.31 / $9.64 / $11.29
| Professional | | $7.31 | $9.64 | $11.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.82 / $5.78 / $7.23
| Professional | | $4.82 | $5.78 | $7.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.02 / $5.78 / $8.75
| Professional | | $2.02 | $5.78 | $8.75 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.40 / $8.18 / $11.32
| Professional | | $5.40 | $8.18 | $11.32 |