- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.46 / $1.46 / $1.46
| Facility | | $1.46 | $1.46 | $1.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.45 / $1.45 / $1.45
| Facility | | $1.45 | $1.45 | $1.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.42 / $0.42 / $0.42
| Professional | | $0.42 | $0.42 | $0.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.56 / $0.56 / $0.56
| Professional | | $0.56 | $0.56 | $0.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.46 / $0.51 / $0.59
| Professional | | $0.46 | $0.51 | $0.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.42 / $0.47 / $0.63
| Professional | | $0.42 | $0.47 | $0.63 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.43 / $0.78 / $2.42
| Professional | | $0.43 | $0.78 | $2.42 |