- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.55 / $5.13 / $93.33
| Facility | | $3.55 | $5.13 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.19 / $3.55 / $4.27
| Professional | | $2.19 | $3.55 | $4.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.16 / $3.16 / $3.16
| Professional | | $3.16 | $3.16 | $3.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.76 / $8.71 / $9.77
| Professional | | $6.76 | $8.71 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.27 / $5.13 / $8.32
| Professional | | $4.27 | $5.13 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.57 / $5.50 / $6.46
| Professional | | $2.57 | $5.50 | $6.46 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.27 / $6.03 / $7.76
| Professional | | $4.27 | $6.03 | $7.76 |