- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.75 / $7.61 / $34.32
| Facility | | $0.75 | $7.61 | $34.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.14 / $0.32 / $0.51
| Professional | | $0.14 | $0.32 | $0.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.35 / $0.35 / $0.35
| Facility | | $0.35 | $0.35 | $0.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.15 / $0.15 / $0.15
| Professional | | $0.15 | $0.15 | $0.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.19 / $0.19 / $0.19
| Professional | | $0.19 | $0.19 | $0.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.17 / $0.18 / $0.22
| Professional | | $0.17 | $0.18 | $0.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.15 / $0.16 / $0.23
| Professional | | $0.15 | $0.16 | $0.23 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.11 / $0.16 / $0.23
| Professional | | $0.11 | $0.16 | $0.23 |