- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.02 / $3.02 / $3.02
| Facility | | $3.02 | $3.02 | $3.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.02 / $3.02 / $3.02
| Facility | | $3.02 | $3.02 | $3.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.51 / $1.51 / $1.51
| Professional | | $1.51 | $1.51 | $1.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.20 / $2.20 / $2.20
| Professional | | $2.20 | $2.20 | $2.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.66 / $1.82 / $2.12
| Professional | | $1.66 | $1.82 | $2.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.51 / $1.82 / $2.27
| Professional | | $1.51 | $1.82 | $2.27 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.51 / $1.81 / $1.95
| Professional | | $1.51 | $1.81 | $1.95 |