- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.08 / $0.08 / $0.08
| Facility | | $0.08 | $0.08 | $0.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.03 / $183.00
| Professional | | $0.02 | $0.03 | $183.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.09 / $0.09 / $0.09
| Facility | | $0.09 | $0.09 | $0.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.03 / $0.03 / $0.03
| Professional | | $0.03 | $0.03 | $0.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.93 / $0.93 / $0.93
| Professional | | $0.93 | $0.93 | $0.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.03 / $0.03 / $0.04
| Professional | | $0.03 | $0.03 | $0.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.03 / $0.04 / $0.05
| Professional | | $0.03 | $0.04 | $0.05 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.03 / $0.35 / $0.90
| Professional | | $0.03 | $0.35 | $0.90 |