- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.47 / $150.47 / $227.02
| Facility | | $150.47 | $150.47 | $227.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.73 / $1.73 / $1.74
| Professional | | $1.73 | $1.73 | $1.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.74 / $1.74 / $2.19
| Professional | | $1.74 | $1.74 | $2.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.66 / $2.66 / $2.66
| Professional | | $2.66 | $2.66 | $2.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.74 / $2.09 / $2.44
| Professional | | $1.74 | $2.09 | $2.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.74 / $2.19 / $2.61
| Professional | | $1.74 | $2.19 | $2.61 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.84 / $1.84 / $2.33
| Professional | | $1.84 | $1.84 | $2.33 |