- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.38 / $1.38 / $1.38
| Facility | | $1.38 | $1.38 | $1.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.98 / $0.98 / $0.98
| Professional | | $0.98 | $0.98 | $0.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.38 / $1.38 / $1.38
| Facility | | $1.38 | $1.38 | $1.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.01 / $1.01 / $1.01
| Professional | | $1.01 | $1.01 | $1.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.00 / $1.00 / $1.00
| Professional | | $1.00 | $1.00 | $1.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.93 / $0.99 / $1.49
| Professional | | $0.93 | $0.99 | $1.49 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.63 / $0.69 / $1.24
| Professional | | $0.63 | $0.69 | $1.24 |