- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.20 / $1.20 / $1.20
| Facility | | $1.20 | $1.20 | $1.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.20 / $1.20 / $1.20
| Facility | | $1.20 | $1.20 | $1.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.95 / $0.95 / $0.95
| Professional | | $0.95 | $0.95 | $0.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.31 / $1.31 / $1.31
| Professional | | $1.31 | $1.31 | $1.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.04 / $1.13 / $1.33
| Professional | | $1.04 | $1.13 | $1.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.95 / $1.08 / $1.43
| Professional | | $0.95 | $1.08 | $1.43 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.79 / $0.95 / $1.71
| Professional | | $0.79 | $0.95 | $1.71 |