- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $57.54 / $67.61
| Facility | | $51.29 | $57.54 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $34.67 / $41.69
| Facility | 26 | $30.90 | $34.67 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $83.18 / $204.17
| Professional | | $44.67 | $83.18 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $38.90 / $107.15
| Professional | 26 | $25.70 | $38.90 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $70.79 / $204.17 / $281.84
| Professional | 50 | $70.79 | $204.17 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $25.70 / $66.07
| Professional | TC | $15.14 | $25.70 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $83.18 / $158.49
| Professional | | $38.02 | $83.18 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $46.77 / $91.20
| Professional | 26 | $24.55 | $46.77 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.45 / $37.15 / $72.44
| Professional | TC | $14.45 | $37.15 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $162.18 / $181.97
| Professional | | $100.00 | $162.18 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $54.95 / $64.57
| Professional | 26 | $52.48 | $54.95 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $120.23
| Professional | TC | $114.82 | $114.82 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $63.10 / $74.13
| Professional | | $57.54 | $63.10 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $38.02 / $44.67
| Professional | 26 | $34.67 | $38.02 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $25.12 / $28.84
| Professional | TC | $22.91 | $25.12 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $87.10 / $141.25
| Professional | | $51.29 | $87.10 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $50.12 / $79.43
| Professional | 26 | $30.90 | $50.12 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $37.15 / $69.18
| Professional | TC | $19.95 | $37.15 | $69.18 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $95.50 / $204.17
| Professional | | $61.66 | $95.50 | $204.17 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $50.12 / $95.50
| Professional | 26 | $38.02 | $50.12 | $95.50 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $43.65 / $114.82
| Professional | TC | $23.99 | $43.65 | $114.82 |