- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $338.84 / $630.96
| Professional | | $295.12 | $338.84 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $91.20 / $199.53
| Professional | 26 | $83.18 | $91.20 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $251.19 / $436.52
| Professional | TC | $208.93 | $251.19 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $354.81 / $371.54
| Professional | | $269.15 | $354.81 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $102.33 / $154.88
| Professional | 26 | $85.11 | $102.33 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $251.19 / $380.19
| Professional | TC | $186.21 | $251.19 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $588.84 / $2,511.89
| Professional | | $478.63 | $588.84 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $158.49 / $165.96 / $177.83
| Professional | 26 | $158.49 | $165.96 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $457.09 / $478.63 / $512.86
| Professional | TC | $457.09 | $478.63 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $354.81 / $446.68
| Professional | | $323.59 | $354.81 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $102.33 / $128.82
| Professional | 26 | $93.33 | $102.33 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $257.04 / $316.23
| Professional | TC | $234.42 | $257.04 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $436.52 / $446.68
| Professional | | $302.00 | $436.52 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $109.65 / $120.23
| Professional | 26 | $83.18 | $109.65 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $316.23 / $331.13
| Professional | TC | $218.78 | $316.23 | $331.13 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $416.87 / $3,548.13
| Professional | | $56.23 | $416.87 | $3,548.13 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $95.50 / $151.36
| Professional | 26 | $13.80 | $95.50 | $151.36 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $302.00 / $489.78
| Professional | TC | $41.69 | $302.00 | $489.78 |