- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $128.82 / $151.36
| Facility | | $112.20 | $128.82 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $17.38 / $20.89
| Facility | 26 | $15.49 | $17.38 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $104.71 / $257.04
| Professional | | $70.79 | $104.71 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $15.14 / $41.69
| Professional | 26 | $12.02 | $15.14 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $87.10 / $138.04
| Professional | TC | $60.26 | $87.10 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $112.20 / $165.96
| Professional | | $75.86 | $112.20 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $19.50 / $30.20
| Professional | 26 | $13.18 | $19.50 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $91.20 / $141.25
| Professional | TC | $63.10 | $91.20 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $162.18 / $181.97
| Professional | | $117.49 | $162.18 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $20.89 / $21.88
| Professional | 26 | $20.42 | $20.89 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $138.04
| Professional | TC | $131.83 | $131.83 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $141.25 / $165.96
| Professional | | $128.82 | $141.25 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $19.05 / $22.39
| Professional | 26 | $17.78 | $19.05 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $112.20 / $123.03 / $141.25
| Professional | TC | $112.20 | $123.03 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $123.03 / $269.15
| Professional | | $85.11 | $123.03 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $25.70 / $125.89
| Professional | 26 | $17.78 | $25.70 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $104.71 / $181.97
| Professional | TC | $85.11 | $104.71 | $181.97 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $165.96 / $199.53
| Professional | | $104.71 | $165.96 | $199.53 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $23.44 / $33.88
| Professional | 26 | $17.78 | $23.44 | $33.88 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $91.20 / $138.04 / $173.78
| Professional | TC | $91.20 | $138.04 | $173.78 |