- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.22 / $2.22 / $2.22
| Facility | | $2.22 | $2.22 | $2.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.54 / $2.54 / $2.67
| Professional | | $2.54 | $2.54 | $2.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.22 / $2.22 / $2.22
| Facility | | $2.22 | $2.22 | $2.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.27 / $2.54 / $2.54
| Professional | | $1.27 | $2.54 | $2.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.22 / $2.22 / $2.22
| Professional | | $2.22 | $2.22 | $2.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.54 / $3.05 / $3.81
| Professional | | $2.54 | $3.05 | $3.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.82 / $2.54 / $3.81
| Professional | | $1.82 | $2.54 | $3.81 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.94 / $1.38 / $3.60
| Professional | | $0.94 | $1.38 | $3.60 |