- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.58 / $22.88 / $288.70
| Facility | | $2.58 | $22.88 | $288.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.11 / $0.15 / $5.90
| Professional | | $0.11 | $0.15 | $5.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.32 / $0.32 / $0.32
| Facility | | $0.32 | $0.32 | $0.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.11 / $0.11 / $0.11
| Professional | | $0.11 | $0.11 | $0.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.15 / $0.15 / $0.15
| Professional | | $0.15 | $0.15 | $0.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.12 / $0.13 / $0.16
| Professional | | $0.12 | $0.13 | $0.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.11 / $0.12 / $0.17
| Professional | | $0.11 | $0.12 | $0.17 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.11 / $0.15 / $0.25
| Professional | | $0.11 | $0.15 | $0.25 |