- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.24 / $2.24 / $2.24
| Facility | | $2.24 | $2.24 | $2.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.23 / $2.23 / $2.23
| Facility | | $2.23 | $2.23 | $2.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.61 / $0.61 / $0.61
| Professional | | $0.61 | $0.61 | $0.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.18 / $1.18 / $1.18
| Professional | | $1.18 | $1.18 | $1.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.67 / $0.73 / $0.85
| Professional | | $0.67 | $0.73 | $0.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.68 / $0.92 / $0.97
| Professional | | $0.68 | $0.92 | $0.97 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.98 / $1.42 / $1.83
| Professional | | $0.98 | $1.42 | $1.83 |