- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.92 / $6.89 / $22.88
| Facility | | $1.92 | $6.89 | $22.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.37 / $1.43 / $1.89
| Professional | | $1.37 | $1.43 | $1.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.91 / $1.91 / $1.91
| Facility | | $1.91 | $1.91 | $1.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.38 / $1.38 / $1.38
| Professional | | $1.38 | $1.38 | $1.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.97 / $1.97 / $1.97
| Professional | | $1.97 | $1.97 | $1.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.51 / $1.65 / $1.93
| Professional | | $1.51 | $1.65 | $1.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.54 / $1.62 / $2.06
| Professional | | $1.54 | $1.62 | $2.06 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.77 / $1.17 / $1.74
| Professional | | $0.77 | $1.17 | $1.74 |