- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $131.83 / $407.38
| Facility | | $93.33 | $131.83 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $39.81 / $46.77
| Facility | 26 | $34.67 | $39.81 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $97.72 / $117.49
| Facility | TC | $81.28 | $97.72 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $138.04 / $363.08
| Professional | | $91.20 | $138.04 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $45.71 / $131.83
| Professional | 26 | $28.84 | $45.71 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $87.10 / $190.55
| Professional | TC | $61.66 | $87.10 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $151.36 / $239.88
| Professional | | $83.18 | $151.36 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $45.71 / $77.62
| Professional | 26 | $28.18 | $45.71 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $102.33 / $162.18
| Professional | TC | $56.23 | $102.33 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $151.36 / $169.82
| Professional | | $53.70 | $151.36 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $46.77 / $48.98
| Professional | 26 | $45.71 | $46.77 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $107.15 / $112.20 / $123.03
| Professional | TC | $107.15 | $112.20 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $141.25 / $162.18
| Professional | | $128.82 | $141.25 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $41.69 / $48.98
| Professional | 26 | $38.02 | $41.69 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $97.72 / $114.82
| Professional | TC | $89.13 | $97.72 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $165.96 / $724.44
| Professional | | $104.71 | $165.96 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $60.26 / $229.09
| Professional | 26 | $37.15 | $60.26 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $114.82 / $575.44
| Professional | TC | $77.62 | $114.82 | $575.44 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $173.78 / $275.42
| Professional | | $144.54 | $173.78 | $275.42 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $52.48 / $77.62
| Professional | 26 | $39.81 | $52.48 | $77.62 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $123.03 / $204.17
| Professional | TC | $100.00 | $123.03 | $204.17 |