- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.40 / $0.40 / $92.00
| Facility | | $0.40 | $0.40 | $92.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.23 / $112.20 / $460.39
| Professional | | $0.23 | $112.20 | $460.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.41 / $0.41 / $0.41
| Facility | | $0.41 | $0.41 | $0.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.23 / $0.23 / $0.23
| Professional | | $0.23 | $0.23 | $0.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.55 / $0.55 / $0.55
| Professional | | $0.55 | $0.55 | $0.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.25 / $0.27 / $0.32
| Professional | | $0.25 | $0.27 | $0.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.27 / $0.60 / $0.90
| Professional | | $0.27 | $0.60 | $0.90 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.22 / $0.25 / $0.38
| Professional | | $0.22 | $0.25 | $0.38 |