- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $109.65 / $234.42
| Facility | | $81.28 | $109.65 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $36.31 / $43.65
| Facility | 26 | $32.36 | $36.31 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $93.33 / $257.04
| Professional | | $50.12 | $93.33 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $51.29 / $114.82
| Professional | 26 | $30.20 | $51.29 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $66.07 / $190.55 / $602.56
| Professional | 50 | $66.07 | $190.55 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $58.88 / $147.91
| Professional | TC | $43.65 | $58.88 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $112.20 / $186.21
| Professional | | $66.07 | $112.20 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $42.66 / $72.44
| Professional | 26 | $25.70 | $42.66 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $70.79 / $114.82
| Professional | TC | $39.81 | $70.79 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $107.15 / $128.82
| Professional | | $51.29 | $107.15 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $42.66 / $44.67
| Professional | 26 | $41.69 | $42.66 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $79.43 / $87.10
| Professional | TC | $75.86 | $79.43 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $109.65 / $128.82
| Professional | | $100.00 | $109.65 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $38.02 / $44.67
| Professional | 26 | $35.48 | $38.02 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $70.79 / $83.18
| Professional | TC | $64.57 | $70.79 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $123.03 / $676.08
| Professional | | $83.18 | $123.03 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $53.70 / $208.93
| Professional | 26 | $34.67 | $53.70 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $75.86 / $128.82
| Professional | TC | $54.95 | $75.86 | $128.82 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $141.25 / $229.09
| Professional | | $112.20 | $141.25 | $229.09 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $50.12 / $81.28
| Professional | 26 | $39.81 | $50.12 | $81.28 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $91.20 / $144.54
| Professional | TC | $72.44 | $91.20 | $144.54 |