- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.32 / $0.32 / $0.35
| Professional | | $0.32 | $0.32 | $0.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.32 / $0.32 / $0.55
| Professional | | $0.32 | $0.32 | $0.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.04 / $2.04 / $2.04
| Professional | | $2.04 | $2.04 | $2.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.32 / $0.39 / $0.45
| Professional | | $0.32 | $0.39 | $0.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.32 / $0.32 / $0.48
| Professional | | $0.32 | $0.32 | $0.48 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.49 / $0.56 / $1.15
| Professional | | $0.49 | $0.56 | $1.15 |