- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.82 / $1.82 / $1.82
| Facility | | $1.82 | $1.82 | $1.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.82 / $1.82 / $1.82
| Facility | | $1.82 | $1.82 | $1.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.26 / $0.26 / $0.26
| Professional | | $0.26 | $0.26 | $0.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.41 / $0.41 / $0.41
| Professional | | $0.41 | $0.41 | $0.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.28 / $0.31 / $0.36
| Professional | | $0.28 | $0.31 | $0.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.26 / $0.34 / $0.39
| Professional | | $0.26 | $0.34 | $0.39 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.34 / $1.10 / $1.27
| Professional | | $0.34 | $1.10 | $1.27 |