- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.68 / $34.32 / $94.06
| Facility | | $22.68 | $34.32 | $94.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.94 / $3.16 / $9.86
| Professional | | $1.94 | $3.16 | $9.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.38 / $5.38 / $5.38
| Facility | | $5.38 | $5.38 | $5.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.95 / $1.95 / $1.95
| Professional | | $1.95 | $1.95 | $1.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.65 / $3.65 / $3.65
| Professional | | $3.65 | $3.65 | $3.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.14 / $2.34 / $2.73
| Professional | | $2.14 | $2.34 | $2.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.95 / $2.93 / $3.00
| Professional | | $1.95 | $2.93 | $3.00 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.85 / $2.75 / $3.41
| Professional | | $1.85 | $2.75 | $3.41 |