- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.16 / $7.65 / $55.28
| Facility | | $3.16 | $7.65 | $55.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.12 / $1.36 / $4.59
| Professional | | $0.12 | $1.36 | $4.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.25 / $0.25 / $0.25
| Facility | | $0.25 | $0.25 | $0.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.09 / $0.09 / $0.09
| Professional | | $0.09 | $0.09 | $0.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.16 / $0.16 / $0.19
| Professional | | $0.16 | $0.16 | $0.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.10 / $0.11 / $0.13
| Professional | | $0.10 | $0.11 | $0.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.09 / $0.13 / $0.14
| Professional | | $0.09 | $0.13 | $0.14 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.09 / $0.14 / $0.25
| Professional | | $0.09 | $0.14 | $0.25 |