- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,083.00 / $23,229.71 / $23,789.46
| Professional | | $22,083.00 | $23,229.71 | $23,789.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,383.52 / $23,789.46 / $23,789.46
| Professional | | $3,383.52 | $23,789.46 | $23,789.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23,170.54 / $23,170.54 / $23,170.54
| Professional | | $23,170.54 | $23,170.54 | $23,170.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $5.00 / $670.00
| Professional | | $5.00 | $5.00 | $670.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,417.91 / $23,323.00 / $34,984.50
| Professional | | $18,417.91 | $23,323.00 | $34,984.50 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,740.70 / $2,740.70 / $2,740.70
| Professional | | $2,740.70 | $2,740.70 | $2,740.70 |