- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.06 / $3.06 / $3.06
| Facility | | $3.06 | $3.06 | $3.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.86 / $1.86 / $3.46
| Professional | | $1.86 | $1.86 | $3.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.06 / $3.06 / $3.06
| Facility | | $3.06 | $3.06 | $3.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.72 / $1.86 / $1.98
| Professional | | $1.72 | $1.86 | $1.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.97 / $1.97 / $1.97
| Professional | | $1.97 | $1.97 | $1.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.86 / $2.23 / $2.79
| Professional | | $1.86 | $2.23 | $2.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.71 / $1.90 / $2.79
| Professional | | $1.71 | $1.90 | $2.79 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.36 / $2.22 / $7.47
| Professional | | $1.36 | $2.22 | $7.47 |