- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $33.88 / $74.13
| Professional | | $18.20 | $33.88 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $15.14 / $38.90
| Professional | 26 | $10.96 | $15.14 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.46 / $10.96 / $15.85
| Professional | TC | $6.46 | $10.96 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $26.30 / $26.30
| Professional | | $26.30 | $26.30 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $15.14 / $15.14
| Professional | 26 | $15.14 | $15.14 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.48 / $11.48 / $11.48
| Professional | TC | $11.48 | $11.48 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $28.18 / $38.90
| Professional | | $15.49 | $28.18 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $18.20 / $25.70
| Professional | 26 | $17.38 | $18.20 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $9.77 / $12.02 / $13.18
| Professional | TC | $9.77 | $12.02 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $27.54 / $40.74
| Professional | | $22.91 | $27.54 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $15.14 / $22.91
| Professional | 26 | $12.88 | $15.14 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.23 / $11.22 / $18.20
| Professional | TC | $10.23 | $11.22 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $12.02 / $35.48
| Professional | | $10.47 | $12.02 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $9.55 / $75.86
| Professional | 26 | $7.41 | $9.55 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2.88 / $4.57 / $15.14
| Professional | TC | $2.88 | $4.57 | $15.14 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $28.84 / $33.88
| Professional | | $19.95 | $28.84 | $33.88 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $17.38 / $22.91
| Professional | 26 | $13.49 | $17.38 | $22.91 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.37 / $11.48 / $14.45
| Professional | TC | $5.37 | $11.48 | $14.45 |