- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.32 / $6.32 / $6.32
| Facility | | $6.32 | $6.32 | $6.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.93 / $3.04 / $1,026.00
| Professional | | $2.93 | $3.04 | $1,026.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.32 / $6.32 / $6.32
| Facility | | $6.32 | $6.32 | $6.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.84 / $2.84 / $2.84
| Professional | | $2.84 | $2.84 | $2.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.34 / $4.34 / $4.34
| Professional | | $4.34 | $4.34 | $4.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.22 / $3.51 / $4.09
| Professional | | $3.22 | $3.51 | $4.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.26 / $3.57 / $4.40
| Professional | | $3.26 | $3.57 | $4.40 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $3.76 / $4.68
| Professional | | $3.00 | $3.76 | $4.68 |