- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.40 / $1.46 / $5.51
| Professional | | $1.40 | $1.46 | $5.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.92 / $1.92 / $1.92
| Facility | | $1.92 | $1.92 | $1.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.41 / $1.41 / $1.41
| Professional | | $1.41 | $1.41 | $1.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.72 / $1.72 / $1.72
| Professional | | $1.72 | $1.72 | $1.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.56 / $1.70 / $1.98
| Professional | | $1.56 | $1.70 | $1.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.41 / $1.41 / $2.12
| Professional | | $1.41 | $1.41 | $2.12 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.74 / $1.27 / $1.92
| Professional | | $0.74 | $1.27 | $1.92 |