- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $38.90 / $281.84
| Facility | | $32.36 | $38.90 | $281.84 |
- 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
- $23.99 / $28.84 / $33.11
| Facility | TC | $23.99 | $28.84 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $43.65 / $112.20
| Professional | | $22.91 | $43.65 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $9.77 / $52.48
| Professional | 26 | $7.08 | $9.77 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $21.88 / $63.10
| Professional | TC | $15.14 | $21.88 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $34.67 / $47.86
| Professional | | $21.88 | $34.67 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $10.96 / $16.60
| Professional | 26 | $7.24 | $10.96 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.79 / $22.91 / $35.48
| Professional | TC | $14.79 | $22.91 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $42.66 / $43.65
| Professional | | $13.49 | $42.66 | $43.65 |
- 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
- $30.90 / $30.90 / $32.36
| Professional | TC | $30.90 | $30.90 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $38.90 / $45.71
| Professional | | $35.48 | $38.90 | $45.71 |
- 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
- $26.30 / $28.18 / $33.11
| Professional | TC | $26.30 | $28.18 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $43.65 / $218.78
| Professional | | $35.48 | $43.65 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $21.38 / $87.10
| Professional | 26 | $10.47 | $21.38 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $34.67 / $147.91
| Professional | TC | $25.12 | $34.67 | $147.91 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $47.86 / $70.79
| Professional | | $39.81 | $47.86 | $70.79 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $13.49 / $21.88
| Professional | 26 | $10.72 | $13.49 | $21.88 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $35.48 / $47.86
| Professional | TC | $26.92 | $35.48 | $47.86 |