- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.26 / $3.26 / $3.26
| Facility | | $3.26 | $3.26 | $3.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.26 / $3.26 / $3.26
| Facility | | $3.26 | $3.26 | $3.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.74 / $1.74 / $1.74
| Professional | | $1.74 | $1.74 | $1.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.66 / $1.66 / $1.66
| Professional | | $1.66 | $1.66 | $1.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.92 / $2.09 / $2.44
| Professional | | $1.92 | $2.09 | $2.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.37 / $1.75 / $2.63
| Professional | | $1.37 | $1.75 | $2.63 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.73 / $1.11 / $1.64
| Professional | | $0.73 | $1.11 | $1.64 |