- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.18 / $10.63 / $108.18
| Facility | | $0.18 | $10.63 | $108.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.05 / $0.05 / $9.17
| Professional | | $0.05 | $0.05 | $9.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.18 / $0.18 / $0.18
| Facility | | $0.18 | $0.18 | $0.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.05 / $0.05 / $0.05
| Professional | | $0.05 | $0.05 | $0.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.10 / $0.10 / $0.10
| Professional | | $0.10 | $0.10 | $0.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.05 / $0.06 / $0.06
| Professional | | $0.05 | $0.06 | $0.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.05 / $0.05 / $0.09
| Professional | | $0.05 | $0.05 | $0.09 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.06 / $0.08 / $0.10
| Professional | | $0.06 | $0.08 | $0.10 |