- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $44.67 / $52.48
| Facility | | $39.81 | $44.67 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $9.77 / $11.75
| Facility | 26 | $8.71 | $9.77 | $11.75 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $37.15 / $41.69
| Facility | TC | $30.90 | $37.15 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $37.15 / $112.20
| Professional | | $26.92 | $37.15 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $12.88 / $51.29
| Professional | 26 | $7.08 | $12.88 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $26.92 / $52.48
| Professional | TC | $18.20 | $26.92 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $43.65 / $61.66
| Professional | | $31.62 | $43.65 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $12.88 / $22.91
| Professional | 26 | $9.33 | $12.88 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $29.51 / $45.71
| Professional | TC | $21.88 | $29.51 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $53.70 / $56.23
| Professional | | $34.67 | $53.70 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $15.14 / $15.85
| Professional | 26 | $14.79 | $15.14 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $40.74
| Professional | TC | $38.90 | $38.90 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $47.86 / $54.95
| Professional | | $43.65 | $47.86 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $10.72 / $12.30
| Professional | 26 | $9.77 | $10.72 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $36.31 / $42.66
| Professional | TC | $33.88 | $36.31 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $52.48 / $251.19
| Professional | | $41.69 | $52.48 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $20.89 / $87.10
| Professional | 26 | $10.00 | $20.89 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $33.88 / $56.23
| Professional | TC | $26.30 | $33.88 | $56.23 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $57.54 / $81.28
| Professional | | $41.69 | $57.54 | $81.28 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $13.80 / $24.55
| Professional | 26 | $10.96 | $13.80 | $24.55 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $44.67 / $54.95
| Professional | TC | $28.84 | $44.67 | $54.95 |