- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.48 / $76.33 / $114.04
| Facility | | $55.48 | $76.33 | $114.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.08 / $1.08 / $1.08
| Professional | | $1.08 | $1.08 | $1.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.96 / $2.96 / $2.96
| Facility | | $2.96 | $2.96 | $2.96 |
- 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
- $1.66 / $1.66 / $1.66
| Professional | | $1.66 | $1.66 | $1.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.18 / $1.29 / $1.50
| Professional | | $1.18 | $1.29 | $1.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.07 / $1.36 / $1.61
| Professional | | $1.07 | $1.36 | $1.61 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.11 / $1.90 / $4.19
| Professional | | $1.11 | $1.90 | $4.19 |