- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.42 / $1.42 / $1.42
| Facility | | $1.42 | $1.42 | $1.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.43 / $1.43 / $1.43
| Facility | | $1.43 | $1.43 | $1.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.83 / $0.83 / $0.83
| Professional | | $0.83 | $0.83 | $0.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.12 / $1.12 / $1.32
| Professional | | $1.12 | $1.12 | $1.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.92 / $1.00 / $1.17
| Professional | | $0.92 | $1.00 | $1.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.83 / $0.93 / $1.25
| Professional | | $0.83 | $0.93 | $1.25 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.62 / $0.79 / $0.99
| Professional | | $0.62 | $0.79 | $0.99 |