- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $45.71 / $53.70
| Facility | | $39.81 | $45.71 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $12.30 / $14.45
| Facility | 26 | $10.72 | $12.30 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $40.74 / $112.20
| Professional | | $23.44 | $40.74 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $12.88 / $60.26
| Professional | 26 | $7.94 | $12.88 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $26.92 / $58.88
| Professional | TC | $16.98 | $26.92 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $40.74 / $58.88
| Professional | | $28.18 | $40.74 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $13.18 / $20.42
| Professional | 26 | $8.91 | $13.18 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $26.30 / $43.65
| Professional | TC | $19.05 | $26.30 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $51.29 / $53.70
| Professional | | $33.11 | $51.29 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $13.80 / $14.45
| Professional | 26 | $13.49 | $13.80 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $38.90
| Professional | TC | $37.15 | $37.15 | $38.90 |
- 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
- $11.75 / $12.88 / $14.79
| Professional | 26 | $11.75 | $12.88 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $34.67 / $40.74
| Professional | TC | $31.62 | $34.67 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $52.48 / $251.19
| Professional | | $42.66 | $52.48 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $17.78 / $87.10
| Professional | 26 | $12.02 | $17.78 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $36.31 / $181.97
| Professional | TC | $29.51 | $36.31 | $181.97 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $56.23 / $74.13
| Professional | | $38.02 | $56.23 | $74.13 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $15.85 / $23.99
| Professional | 26 | $12.02 | $15.85 | $23.99 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $42.66 / $51.29
| Professional | TC | $26.30 | $42.66 | $51.29 |