- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.88 / $3.88 / $53.40
| Facility | | $3.88 | $3.88 | $53.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.59 / $1.63 / $2.15
| Professional | | $1.59 | $1.63 | $2.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.87 / $3.87 / $3.87
| Facility | | $3.87 | $3.87 | $3.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.57 / $1.57 / $1.57
| Professional | | $1.57 | $1.57 | $1.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.41 / $2.41 / $2.41
| Professional | | $2.41 | $2.41 | $2.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.73 / $1.89 / $2.20
| Professional | | $1.73 | $1.89 | $2.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.57 / $1.98 / $2.36
| Professional | | $1.57 | $1.98 | $2.36 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.60 / $2.23 / $4.32
| Professional | | $1.60 | $2.23 | $4.32 |