- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $50.12 / $346.74
| Facility | | $43.65 | $50.12 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $10.23 / $12.02
| Facility | 26 | $9.12 | $10.23 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $44.67 / $363.08
| Facility | TC | $35.48 | $44.67 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $46.77 / $181.97
| Professional | | $13.80 | $46.77 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $16.22 / $52.48
| Professional | 26 | $7.94 | $16.22 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $19.05 / $95.50 / $245.47
| Professional | 50 | $19.05 | $95.50 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $36.31 / $97.72
| Professional | TC | $23.99 | $36.31 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $46.77 / $66.07
| Professional | | $30.20 | $46.77 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $11.22 / $16.98
| Professional | 26 | $8.13 | $11.22 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $31.62 / $52.48
| Professional | TC | $21.88 | $31.62 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $60.26 / $64.57
| Professional | | $40.74 | $60.26 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $12.02 / $12.59
| Professional | 26 | $11.75 | $12.02 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $45.71 / $47.86 / $54.95
| Professional | TC | $45.71 | $47.86 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $56.23 / $66.07
| Professional | | $51.29 | $56.23 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $11.48 / $13.49
| Professional | 26 | $10.47 | $11.48 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $44.67 / $52.48
| Professional | TC | $40.74 | $44.67 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $57.54 / $295.12
| Professional | | $43.65 | $57.54 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $19.50 / $87.10
| Professional | 26 | $10.47 | $19.50 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $44.67 / $223.87
| Professional | TC | $32.36 | $44.67 | $223.87 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $64.57 / $81.28
| Professional | | $39.81 | $64.57 | $81.28 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $13.80 / $19.95
| Professional | 26 | $10.23 | $13.80 | $19.95 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $48.98 / $60.26
| Professional | TC | $31.62 | $48.98 | $60.26 |