- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.98 / $1.98 / $1.98
| Facility | | $1.98 | $1.98 | $1.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.01 / $1.04 / $1.37
| Professional | | $1.01 | $1.04 | $1.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.97 / $1.97 / $1.97
| Facility | | $1.97 | $1.97 | $1.97 |
- 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
- $1.43 / $1.43 / $1.43
| Professional | | $1.43 | $1.43 | $1.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.10 / $1.20 / $1.39
| Professional | | $1.10 | $1.20 | $1.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.11 / $1.18 / $1.50
| Professional | | $1.11 | $1.18 | $1.50 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.98 / $1.19 / $1.26
| Professional | | $0.98 | $1.19 | $1.26 |