- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.11 / $30.34 / $95.62
| Facility | | $3.11 | $30.34 | $95.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.09 / $0.12 / $17.44
| Professional | | $0.09 | $0.12 | $17.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.28 / $0.28 / $0.28
| Facility | | $0.28 | $0.28 | $0.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.09 / $0.09 / $0.09
| Professional | | $0.09 | $0.09 | $0.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.12 / $0.12 / $0.12
| Professional | | $0.12 | $0.12 | $0.12 |
- 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
- $0.09 / $0.10 / $0.14
| Professional | | $0.09 | $0.10 | $0.14 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.09 / $0.14 / $0.18
| Professional | | $0.09 | $0.14 | $0.18 |