- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.48 / $0.48 / $0.48
| Facility | | $0.48 | $0.48 | $0.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.19 / $0.19 / $0.24
| Professional | | $0.19 | $0.19 | $0.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.48 / $0.48 / $0.48
| Facility | | $0.48 | $0.48 | $0.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.19 / $0.19 / $0.27
| Professional | | $0.19 | $0.19 | $0.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.26 / $0.26 / $0.26
| Professional | | $0.26 | $0.26 | $0.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.19 / $0.23 / $0.28
| Professional | | $0.19 | $0.23 | $0.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.18 / $0.19 / $0.28
| Professional | | $0.18 | $0.19 | $0.28 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.16 / $0.28 / $0.41
| Professional | | $0.16 | $0.28 | $0.41 |