- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.24 / $0.24 / $0.32
| Professional | | $0.24 | $0.24 | $0.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.00 / $85.00 / $85.00
| Facility | | $85.00 | $85.00 | $85.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.24 / $0.24 / $0.35
| Professional | | $0.24 | $0.24 | $0.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.42 / $0.44 / $0.44
| Professional | | $0.42 | $0.44 | $0.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.27 / $0.28 / $0.34
| Professional | | $0.27 | $0.28 | $0.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.15 / $0.24 / $0.36
| Professional | | $0.15 | $0.24 | $0.36 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.15 / $0.36 / $0.39
| Professional | | $0.15 | $0.36 | $0.39 |