- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.03 / $0.04 / $0.07
| Professional | | $0.03 | $0.04 | $0.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.07 / $0.07 / $0.07
| Facility | | $0.07 | $0.07 | $0.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.04 / $0.06 / $0.12
| Professional | | $0.04 | $0.06 | $0.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.08 / $0.08 / $0.08
| Professional | | $0.08 | $0.08 | $0.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.06 / $0.08 / $0.11
| Professional | | $0.06 | $0.08 | $0.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.03 / $0.04 / $0.11
| Professional | | $0.03 | $0.04 | $0.11 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.07 / $0.07 / $0.08
| Professional | | $0.07 | $0.07 | $0.08 |