- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $3,467.37 / $3,890.45
| Facility | | $1,148.15 | $3,467.37 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $338.84 / $851.14
| Professional | | $177.83 | $338.84 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $83.18 / $144.54 / $269.15
| Professional | 53 | $83.18 | $144.54 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,096.48 / $1,096.48
| Facility | | $1,096.48 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $407.38 / $851.14
| Professional | | $229.09 | $407.38 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $67.61 / $194.98 / $263.03
| Professional | 53 | $67.61 | $194.98 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $436.52 / $630.96
| Professional | | $363.08 | $436.52 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $407.38 / $575.44
| Professional | | $181.97 | $407.38 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $91.20 / $204.17 / $288.40
| Professional | 53 | $91.20 | $204.17 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $1,698.24 / $1,698.24
| Facility | | $1,698.24 | $1,698.24 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $331.13 / $549.54
| Professional | | $181.97 | $331.13 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $102.33 / $190.55 / $218.78
| Professional | 53 | $102.33 | $190.55 | $218.78 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $2,041.74 / $5,495.41
| Professional | | $251.19 | $2,041.74 | $5,495.41 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $102.33 / $1,548.82 / $4,073.80
| Professional | 53 | $102.33 | $1,548.82 | $4,073.80 |