- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.00 / $1.00 / $1.00
| Facility | | $1.00 | $1.00 | $1.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.56 / $0.56 / $0.78
| Professional | | $0.56 | $0.56 | $0.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.01 / $1.01 / $1.01
| Facility | | $1.01 | $1.01 | $1.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.34 / $0.56 / $0.56
| Professional | | $0.34 | $0.56 | $0.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.36 / $0.36 / $0.36
| Professional | | $0.36 | $0.36 | $0.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.56 / $0.68 / $0.85
| Professional | | $0.56 | $0.68 | $0.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.34 / $0.56 / $0.86
| Professional | | $0.34 | $0.56 | $0.86 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.32 / $0.56 / $5.38
| Professional | | $0.32 | $0.56 | $5.38 |