- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47,154.00 / $47,154.00 / $47,154.00
| Facility | | $47,154.00 | $47,154.00 | $47,154.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $28,424.06 / $31,266.46
| Professional | | $28,424.06 | $28,424.06 | $31,266.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47,154.02 / $47,154.02 / $47,154.02
| Facility | | $47,154.02 | $47,154.02 | $47,154.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27,231.45 / $28,424.06 / $32,484.64
| Professional | | $27,231.45 | $28,424.06 | $32,484.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33,702.81 / $33,702.81 / $33,702.81
| Professional | | $33,702.81 | $33,702.81 | $33,702.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $34,108.87 / $39,793.68
| Professional | | $28,424.06 | $34,108.87 | $39,793.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27,611.94 / $28,424.06 / $42,636.09
| Professional | | $27,611.94 | $28,424.06 | $42,636.09 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,272.22 / $17,927.59 / $32,755.34
| Professional | | $3,272.22 | $17,927.59 | $32,755.34 |