- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.70 / $2.04 / $2.56
| Professional | | $1.70 | $2.04 | $2.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $3.01 / $5.00
| Professional | | $2.00 | $3.01 | $5.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.82 / $2.95 / $3.39
| Professional | | $2.82 | $2.95 | $3.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.99 / $2.65 / $3.06
| Professional | | $1.99 | $2.65 | $3.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.14 / $2.49 / $3.56
| Professional | | $2.14 | $2.49 | $3.56 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.88 / $2.52 / $2.56
| Professional | | $1.88 | $2.52 | $2.56 |