- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,349.50 / $17,349.50 / $17,349.50
| Professional | | $17,349.50 | $17,349.50 | $17,349.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37,505.21 / $37,505.21 / $37,505.21
| Facility | | $37,505.21 | $37,505.21 | $37,505.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31,290.51 / $31,290.51 / $51,932.40
| Professional | | $31,290.51 | $31,290.51 | $51,932.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47,211.27 / $49,435.87 / $49,435.87
| Professional | | $47,211.27 | $49,435.87 | $49,435.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,326.76 / $47,211.27 / $66,095.78
| Professional | | $28,326.76 | $47,211.27 | $66,095.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32,901.71 / $37,505.21 / $51,932.40
| Professional | | $32,901.71 | $37,505.21 | $51,932.40 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38,030.46 / $39,333.82 / $44,936.41
| Professional | | $38,030.46 | $39,333.82 | $44,936.41 |