- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.28 / $0.53 / $0.81
| Professional | | $0.28 | $0.53 | $0.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.80 / $0.80 / $0.80
| Facility | | $0.80 | $0.80 | $0.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.52 / $0.72 / $1.19
| Professional | | $0.52 | $0.72 | $1.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.02 / $1.07 / $1.07
| Professional | | $1.02 | $1.07 | $1.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.71 / $1.02 / $2.16
| Professional | | $0.71 | $1.02 | $2.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.34 / $0.68 / $1.12
| Professional | | $0.34 | $0.68 | $1.12 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.82 / $0.85 / $0.97
| Professional | | $0.82 | $0.85 | $0.97 |