- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.78 / $5.41 / $6.95
| Facility | | $4.78 | $5.41 | $6.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.49 / $7.95 / $37.00
| Professional | | $5.49 | $7.95 | $37.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.73 / $6.95 / $6.95
| Professional | | $3.73 | $6.95 | $6.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.73 / $10.19 / $11.95
| Professional | | $7.73 | $10.19 | $11.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.79 / $6.95 / $8.69
| Professional | | $5.79 | $6.95 | $8.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.47 / $6.95 / $9.22
| Professional | | $3.47 | $6.95 | $9.22 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.48 / $8.57 / $11.95
| Professional | | $6.48 | $8.57 | $11.95 |