- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.58 / $3.58 / $3.58
| Facility | | $3.58 | $3.58 | $3.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.57 / $3.57 / $3.57
| Facility | | $3.57 | $3.57 | $3.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.45 / $1.45 / $1.45
| Professional | | $1.45 | $1.45 | $1.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.91 / $1.91 / $1.91
| Professional | | $1.91 | $1.91 | $1.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.60 / $1.74 / $2.04
| Professional | | $1.60 | $1.74 | $2.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.45 / $1.57 / $2.18
| Professional | | $1.45 | $1.57 | $2.18 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.41 / $1.92 / $5.44
| Professional | | $1.41 | $1.92 | $5.44 |