- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.78 / $0.78 / $0.78
| Facility | | $0.78 | $0.78 | $0.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.19 / $0.19 / $0.40
| Professional | | $0.19 | $0.19 | $0.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.77 / $0.77 / $0.77
| Facility | | $0.77 | $0.77 | $0.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.18 / $0.18 / $0.36
| Professional | | $0.18 | $0.18 | $0.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.34 / $0.34 / $0.34
| Professional | | $0.34 | $0.34 | $0.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.19 / $0.22 / $0.28
| Professional | | $0.19 | $0.22 | $0.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.19 / $0.20 / $0.31
| Professional | | $0.19 | $0.20 | $0.31 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.26 / $0.37 / $0.89
| Professional | | $0.26 | $0.37 | $0.89 |