- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.43 / $0.43 / $0.43
| Professional | | $0.43 | $0.43 | $0.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.71 / $0.71 / $0.71
| Facility | | $0.71 | $0.71 | $0.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.64 / $0.64 / $0.99
| Professional | | $0.64 | $0.64 | $0.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.90 / $0.94 / $0.94
| Professional | | $0.90 | $0.94 | $0.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.63 / $0.90 / $1.26
| Professional | | $0.63 | $0.90 | $1.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.45 / $0.84 / $0.99
| Professional | | $0.45 | $0.84 | $0.99 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.72 / $0.75 / $0.86
| Professional | | $0.72 | $0.75 | $0.86 |