- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,855.56 / $15,855.56 / $15,855.56
| Professional | | $15,855.56 | $15,855.56 | $15,855.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37,307.40 / $37,307.40 / $37,307.40
| Facility | | $37,307.40 | $37,307.40 | $37,307.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30,391.12 / $30,391.12 / $51,658.50
| Professional | | $30,391.12 | $30,391.12 | $51,658.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46,962.27 / $49,175.13 / $49,175.13
| Professional | | $46,962.27 | $49,175.13 | $49,175.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,177.36 / $46,962.27 / $65,747.17
| Professional | | $28,177.36 | $46,962.27 | $65,747.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29,933.07 / $37,307.40 / $51,658.50
| Professional | | $29,933.07 | $37,307.40 | $51,658.50 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,538.23 / $37,829.87 / $44,699.41
| Professional | | $20,538.23 | $37,829.87 | $44,699.41 |