- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.84 / $7.92 / $22.88
| Facility | | $4.84 | $7.92 | $22.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.09 / $1.10 / $1.49
| Professional | | $1.09 | $1.10 | $1.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.12 / $2.12 / $2.12
| Facility | | $2.12 | $2.12 | $2.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.09 / $1.09 / $1.09
| Professional | | $1.09 | $1.09 | $1.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.50 / $1.50 / $1.50
| Professional | | $1.50 | $1.50 | $1.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.19 / $1.30 / $1.52
| Professional | | $1.19 | $1.30 | $1.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.21 / $1.24 / $1.64
| Professional | | $1.21 | $1.24 | $1.64 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.77 / $1.15 / $1.44
| Professional | | $0.77 | $1.15 | $1.44 |