- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.82 / $1.82 / $1.82
| Facility | | $1.82 | $1.82 | $1.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.82 / $1.82 / $1.82
| Facility | | $1.82 | $1.82 | $1.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.63 / $0.63 / $0.63
| Professional | | $0.63 | $0.63 | $0.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.79 / $0.79 / $0.79
| Professional | | $0.79 | $0.79 | $0.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.70 / $0.76 / $0.89
| Professional | | $0.70 | $0.76 | $0.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.63 / $0.65 / $0.95
| Professional | | $0.63 | $0.65 | $0.95 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.70 / $1.08 / $1.85
| Professional | | $0.70 | $1.08 | $1.85 |