- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.90 / $0.90 / $0.90
| Facility | | $0.90 | $0.90 | $0.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.91 / $0.91 / $0.91
| Facility | | $0.91 | $0.91 | $0.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.45 / $0.45 / $0.45
| Professional | | $0.45 | $0.45 | $0.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.69 / $0.69 / $0.69
| Professional | | $0.69 | $0.69 | $0.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.50 / $0.54 / $0.64
| Professional | | $0.50 | $0.54 | $0.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.45 / $0.56 / $0.68
| Professional | | $0.45 | $0.56 | $0.68 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.37 / $0.56 / $0.76
| Professional | | $0.37 | $0.56 | $0.76 |