- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.07 / $22.88 / $31.69
| Facility | | $3.07 | $22.88 | $31.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.76 / $1.32 / $3.65
| Professional | | $0.76 | $1.32 | $3.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.34 / $2.34 / $2.34
| Facility | | $2.34 | $2.34 | $2.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.76 / $0.76 / $0.76
| Professional | | $0.76 | $0.76 | $0.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.07 / $1.07 / $1.07
| Professional | | $1.07 | $1.07 | $1.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.83 / $0.91 / $1.06
| Professional | | $0.83 | $0.91 | $1.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.85 / $0.88 / $1.13
| Professional | | $0.85 | $0.88 | $1.13 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.71 / $0.90 / $1.45
| Professional | | $0.71 | $0.90 | $1.45 |