- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.55 / $19.79 / $538.37
| Facility | | $9.55 | $19.79 | $538.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.12 / $5.00 / $20.35
| Professional | | $1.12 | $5.00 | $20.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.18 / $2.18 / $2.18
| Facility | | $2.18 | $2.18 | $2.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.84 / $0.84 / $0.84
| Professional | | $0.84 | $0.84 | $0.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.89 / $1.89 / $1.89
| Professional | | $1.89 | $1.89 | $1.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.93 / $1.01 / $1.18
| Professional | | $0.93 | $1.01 | $1.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.84 / $1.08 / $1.26
| Professional | | $0.84 | $1.08 | $1.26 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.86 / $1.15 / $2.38
| Professional | | $0.86 | $1.15 | $2.38 |