- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.77 / $15.16 / $22.34
| Professional | | $7.77 | $15.16 | $22.34 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $12.53 / $12.53 / $12.53
| Professional | 25 | $12.53 | $12.53 | $12.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.41 / $19.01 / $23.46
| Professional | | $13.41 | $19.01 | $23.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.65 / $24.31 / $24.31
| Professional | | $22.65 | $24.31 | $24.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.88 / $19.01 / $26.10
| Professional | | $9.88 | $19.01 | $26.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.36 / $23.30 / $29.97
| Professional | | $16.36 | $23.30 | $29.97 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.76 / $20.76 / $20.76
| Professional | | $20.76 | $20.76 | $20.76 |