- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.29 / $10.00 / $129.59
| Facility | | $3.29 | $10.00 | $129.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.89 / $1.13 / $2.59
| Professional | | $0.89 | $1.13 | $2.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.79 / $1.79 / $1.79
| Facility | | $1.79 | $1.79 | $1.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.10 / $1.10 / $1.10
| Professional | | $1.10 | $1.10 | $1.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.24 / $1.24 / $1.24
| Professional | | $1.24 | $1.24 | $1.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.21 / $1.32 / $1.54
| Professional | | $1.21 | $1.32 | $1.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.02 / $1.10 / $1.65
| Professional | | $1.02 | $1.10 | $1.65 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.56 / $0.90 / $1.19
| Professional | | $0.56 | $0.90 | $1.19 |