- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.24 / $8.48 / $126.67
| Facility | | $2.24 | $8.48 | $126.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.08 / $0.40 / $4.63
| Professional | | $0.08 | $0.40 | $4.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.17 / $0.17 / $0.17
| Facility | | $0.17 | $0.17 | $0.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.82 / $0.82 / $0.82
| Professional | | $0.82 | $0.82 | $0.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.13 / $0.13 / $0.13
| Professional | | $0.13 | $0.13 | $0.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.10 / $0.11 / $0.13
| Professional | | $0.10 | $0.11 | $0.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.11 / $0.14 / $1.43
| Professional | | $0.11 | $0.14 | $1.43 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.06 / $0.10 / $7.33
| Professional | | $0.06 | $0.10 | $7.33 |