- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.14 / $0.14 / $0.14
| Facility | | $0.14 | $0.14 | $0.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.10 / $0.13 / $9.43
| Professional | | $0.10 | $0.13 | $9.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.14 / $0.14 / $0.14
| Facility | | $0.14 | $0.14 | $0.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.10 / $0.10 / $0.10
| Professional | | $0.10 | $0.10 | $0.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.16 / $0.16 / $0.16
| Professional | | $0.16 | $0.16 | $0.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.11 / $0.12 / $0.14
| Professional | | $0.11 | $0.12 | $0.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.10 / $0.13 / $0.15
| Professional | | $0.10 | $0.13 | $0.15 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.08 / $0.13
| Professional | | $0.02 | $0.08 | $0.13 |