- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.19 / $24.71 / $68.13
| Facility | | $14.19 | $24.71 | $68.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.26 / $1.62 / $3.58
| Professional | | $1.26 | $1.62 | $3.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.69 / $2.69 / $2.69
| Facility | | $2.69 | $2.69 | $2.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.26 / $1.26 / $1.26
| Professional | | $1.26 | $1.26 | $1.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.83 / $1.83 / $1.83
| Professional | | $1.83 | $1.83 | $1.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.39 / $1.51 / $1.76
| Professional | | $1.39 | $1.51 | $1.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.26 / $1.50 / $1.89
| Professional | | $1.26 | $1.50 | $1.89 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.92 / $1.51 / $1.70
| Professional | | $0.92 | $1.51 | $1.70 |