- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.78 / $0.78 / $0.78
| Facility | | $0.78 | $0.78 | $0.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.28 / $0.28 / $0.28
| Professional | | $0.28 | $0.28 | $0.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.79 / $0.79 / $0.79
| Facility | | $0.79 | $0.79 | $0.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.28 / $0.28 / $0.28
| Professional | | $0.28 | $0.28 | $0.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.57 / $0.57 / $0.57
| Professional | | $0.57 | $0.57 | $0.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.31 / $0.34 / $0.39
| Professional | | $0.31 | $0.34 | $0.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.31 / $0.42 / $0.48
| Professional | | $0.31 | $0.42 | $0.48 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.37 / $0.51 / $0.76
| Professional | | $0.37 | $0.51 | $0.76 |