- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,441.66 / $10,441.66 / $10,441.66
| Professional | | $10,441.66 | $10,441.66 | $10,441.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,876.27 / $22,876.27 / $22,876.27
| Facility | | $22,876.27 | $22,876.27 | $22,876.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,200.25 / $16,200.25 / $31,676.11
| Professional | | $16,200.25 | $16,200.25 | $31,676.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,796.46 / $30,153.35 / $30,153.35
| Professional | | $28,796.46 | $30,153.35 | $30,153.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,157.52 / $28,796.46 / $40,315.04
| Professional | | $20,157.52 | $28,796.46 | $40,315.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,068.37 / $22,876.27 / $31,676.11
| Professional | | $20,068.37 | $22,876.27 | $31,676.11 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,068.37 / $23,991.62 / $27,408.91
| Professional | | $20,068.37 | $23,991.62 | $27,408.91 |