- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.48 / $3.48 / $3.48
| Facility | | $3.48 | $3.48 | $3.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.86 / $1.86 / $2.04
| Professional | | $1.86 | $1.86 | $2.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.47 / $3.47 / $3.47
| Facility | | $3.47 | $3.47 | $3.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.82 / $1.86 / $2.10
| Professional | | $1.82 | $1.86 | $2.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.37 / $2.37 / $2.37
| Professional | | $2.37 | $2.37 | $2.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.86 / $2.23 / $2.78
| Professional | | $1.86 | $2.23 | $2.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.67 / $1.86 / $2.79
| Professional | | $1.67 | $1.86 | $2.79 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.82 / $2.09 / $2.50
| Professional | | $1.82 | $2.09 | $2.50 |