- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.57 / $5.50 / $6.61
| Facility | | $4.57 | $5.50 | $6.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $5.01 / $5.01
| Professional | | $3.98 | $5.01 | $5.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.47 / $4.47 / $6.61
| Professional | | $4.47 | $4.47 | $6.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.55 / $13.80 / $13.80
| Professional | | $9.55 | $13.80 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.62 / $6.61 / $10.00
| Professional | | $5.62 | $6.61 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.34 / $7.76 / $10.72
| Professional | | $2.34 | $7.76 | $10.72 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.31 / $10.00 / $14.13
| Professional | | $6.31 | $10.00 | $14.13 |