- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.54 / $0.54 / $0.54
| Facility | | $0.54 | $0.54 | $0.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.06 / $0.08 / $293.86
| Professional | | $0.06 | $0.08 | $293.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.53 / $0.53 / $0.53
| Facility | | $0.53 | $0.53 | $0.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.06 / $0.06 / $0.06
| Professional | | $0.06 | $0.06 | $0.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.06 / $0.06 / $0.06
| Professional | | $0.06 | $0.06 | $0.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.06 / $0.07 / $0.08
| Professional | | $0.06 | $0.07 | $0.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.05 / $0.07 / $0.09
| Professional | | $0.05 | $0.07 | $0.09 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.04 / $0.21 / $0.39
| Professional | | $0.04 | $0.21 | $0.39 |