- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $222.96 / $222.96 / $222.96
| Facility | | $222.96 | $222.96 | $222.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $3.14 / $74.25
| Professional | | $3.02 | $3.14 | $74.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.84 / $4.84 / $4.84
| Facility | | $4.84 | $4.84 | $4.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.77 / $3.02 / $4.09
| Professional | | $2.77 | $3.02 | $4.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.13 / $4.13 / $4.13
| Professional | | $4.13 | $4.13 | $4.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $3.62 / $4.53
| Professional | | $3.02 | $3.62 | $4.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $3.20 / $4.53
| Professional | | $3.02 | $3.20 | $4.53 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.04 / $3.44 / $5.58
| Professional | | $2.04 | $3.44 | $5.58 |