- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.00 / $4.53 / $5.82
| Facility | | $4.00 | $4.53 | $5.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.94 / $5.82 / $5.82
| Professional | | $2.94 | $5.82 | $5.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.99 / $7.90 / $9.24
| Professional | | $5.99 | $7.90 | $9.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.84 / $5.82 / $7.28
| Professional | | $4.84 | $5.82 | $7.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.04 / $5.82 / $7.28
| Professional | | $2.04 | $5.82 | $7.28 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.41 / $6.70 / $9.27
| Professional | | $5.41 | $6.70 | $9.27 |