- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.70 / $4.20 / $5.39
| Facility | | $3.70 | $4.20 | $5.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.94 / $5.39 / $5.39
| Professional | | $2.94 | $5.39 | $5.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $7.96 / $9.30
| Professional | | $6.03 | $7.96 | $9.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.49 / $5.39 / $6.74
| Professional | | $4.49 | $5.39 | $6.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.89 / $5.39 / $7.24
| Professional | | $1.89 | $5.39 | $7.24 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.03 / $6.76 / $9.61
| Professional | | $5.03 | $6.76 | $9.61 |