- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.08 / $0.08 / $0.08
| Professional | | $0.08 | $0.08 | $0.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.13 / $0.13 / $0.13
| Facility | | $0.13 | $0.13 | $0.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.11 / $0.11 / $0.17
| Professional | | $0.11 | $0.11 | $0.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.15 / $0.16 / $0.16
| Professional | | $0.15 | $0.16 | $0.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.11 / $0.15 / $0.21
| Professional | | $0.11 | $0.15 | $0.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.07 / $0.12 / $0.15
| Professional | | $0.07 | $0.12 | $0.15 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.12 / $0.13 / $0.15
| Professional | | $0.12 | $0.13 | $0.15 |