- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.32 / $7.00 / $29.10
| Facility | | $5.32 | $7.00 | $29.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.20 / $2.76 / $4.80
| Professional | | $2.20 | $2.76 | $4.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.32 / $5.32 / $5.32
| Facility | | $5.32 | $5.32 | $5.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.21 / $2.21 / $2.21
| Professional | | $2.21 | $2.21 | $2.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.61 / $3.61 / $3.61
| Professional | | $3.61 | $3.61 | $3.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.43 / $2.65 / $3.09
| Professional | | $2.43 | $2.65 | $3.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.21 / $2.96 / $3.32
| Professional | | $2.21 | $2.96 | $3.32 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.90 / $2.62 / $3.60
| Professional | | $1.90 | $2.62 | $3.60 |