- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.56 / $1.56 / $1.56
| Facility | | $1.56 | $1.56 | $1.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.79 / $0.79 / $0.79
| Professional | | $0.79 | $0.79 | $0.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.56 / $1.56 / $1.56
| Facility | | $1.56 | $1.56 | $1.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.79 / $0.79 / $0.79
| Professional | | $0.79 | $0.79 | $0.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.10 / $1.10 / $1.10
| Professional | | $1.10 | $1.10 | $1.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.87 / $0.95 / $1.11
| Professional | | $0.87 | $0.95 | $1.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.79 / $0.90 / $1.19
| Professional | | $0.79 | $0.90 | $1.19 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.52 / $0.91 / $1.27
| Professional | | $0.52 | $0.91 | $1.27 |