- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.06 / $2.06 / $2.06
| Facility | | $2.06 | $2.06 | $2.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.06 / $2.06 / $2.06
| Facility | | $2.06 | $2.06 | $2.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.77 / $0.77 / $0.77
| Professional | | $0.77 | $0.77 | $0.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.42 / $1.42 / $1.42
| Professional | | $1.42 | $1.42 | $1.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.85 / $0.93 / $1.08
| Professional | | $0.85 | $0.93 | $1.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.77 / $1.15 / $1.17
| Professional | | $0.77 | $1.15 | $1.17 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.06 / $1.44 / $6.63
| Professional | | $1.06 | $1.44 | $6.63 |