- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $38.90 / $281.84
| Facility | | $33.88 | $38.90 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $9.55 / $11.22
| Facility | 26 | $8.32 | $9.55 | $11.22 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $36.31 / $371.54
| Facility | TC | $27.54 | $36.31 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $37.15 / $134.90
| Professional | | $12.88 | $37.15 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $12.30 / $41.69
| Professional | 26 | $7.08 | $12.30 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $57.54 / $173.78 / $190.55
| Professional | 50 | $57.54 | $173.78 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $28.84 / $72.44
| Professional | TC | $19.05 | $28.84 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $43.65 / $53.70
| Professional | | $29.51 | $43.65 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $10.47 / $15.85
| Professional | 26 | $6.92 | $10.47 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $30.90 / $41.69
| Professional | TC | $22.39 | $30.90 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $46.77 / $48.98
| Professional | | $31.62 | $46.77 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $10.96 / $11.48
| Professional | 26 | $10.72 | $10.96 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $35.48 / $37.15
| Professional | TC | $34.67 | $35.48 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $43.65 / $51.29
| Professional | | $39.81 | $43.65 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $10.23 / $12.02
| Professional | 26 | $9.33 | $10.23 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $33.88 / $38.90
| Professional | TC | $30.90 | $33.88 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $46.77 / $234.42
| Professional | | $38.90 | $46.77 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $18.20 / $87.10
| Professional | 26 | $9.77 | $18.20 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $33.11 / $165.96
| Professional | TC | $28.84 | $33.11 | $165.96 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $51.29 / $72.44
| Professional | | $36.31 | $51.29 | $72.44 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $12.59 / $18.62
| Professional | 26 | $9.33 | $12.59 | $18.62 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $39.81 / $54.95
| Professional | TC | $28.18 | $39.81 | $54.95 |