- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.88 / $0.88 / $0.88
| Facility | | $0.88 | $0.88 | $0.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.56 / $0.57 / $4.11
| Professional | | $0.56 | $0.57 | $4.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.87 / $0.87 / $0.87
| Facility | | $0.87 | $0.87 | $0.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.56 / $0.56 / $0.56
| Professional | | $0.56 | $0.56 | $0.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.47 / $0.47 / $0.47
| Professional | | $0.47 | $0.47 | $0.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.61 / $0.67 / $0.78
| Professional | | $0.61 | $0.67 | $0.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.38 / $0.56 / $0.84
| Professional | | $0.38 | $0.56 | $0.84 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.41 / $0.73 / $0.86
| Professional | | $0.41 | $0.73 | $0.86 |