- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $44.67 / $223.87
| Facility | | $34.67 | $44.67 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $9.12 / $10.72
| Facility | 26 | $8.13 | $9.12 | $10.72 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $34.67 / $40.74
| Facility | TC | $28.84 | $34.67 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $38.02 / $154.88
| Professional | | $10.72 | $38.02 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $11.48 / $46.77
| Professional | 26 | $6.03 | $11.48 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $46.77 / $190.55 / $208.93
| Professional | 50 | $46.77 | $190.55 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $26.92 / $77.62
| Professional | TC | $16.98 | $26.92 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $38.90 / $54.95
| Professional | | $26.30 | $38.90 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $10.47 / $15.14
| Professional | 26 | $7.94 | $10.47 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $25.70 / $43.65
| Professional | TC | $18.20 | $25.70 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $48.98 / $51.29
| Professional | | $31.62 | $48.98 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $11.48 / $12.02
| Professional | 26 | $11.22 | $11.48 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $38.02 / $39.81
| Professional | TC | $37.15 | $38.02 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $45.71 / $53.70
| Professional | | $41.69 | $45.71 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $9.77 / $11.48
| Professional | 26 | $9.12 | $9.77 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $35.48 / $41.69
| Professional | TC | $33.11 | $35.48 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $48.98 / $239.88
| Professional | | $37.15 | $48.98 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $16.22 / $87.10
| Professional | 26 | $9.55 | $16.22 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $33.88 / $186.21
| Professional | TC | $25.70 | $33.88 | $186.21 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $53.70 / $70.79
| Professional | | $33.11 | $53.70 | $70.79 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $12.02 / $17.78
| Professional | 26 | $9.12 | $12.02 | $17.78 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $40.74 / $52.48
| Professional | TC | $24.55 | $40.74 | $52.48 |