- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $912.01 / $2,754.23
| Professional | | $724.44 | $912.01 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $158.49 / $389.05
| Professional | 26 | $107.15 | $158.49 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $602.56 / $741.31 / $1,412.54
| Professional | TC | $602.56 | $741.31 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,096.48 / $1,778.28
| Professional | | $794.33 | $1,096.48 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $134.90 / $204.17 / $331.13
| Professional | 26 | $134.90 | $204.17 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $630.96 / $870.96 / $1,445.44
| Professional | TC | $630.96 | $870.96 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,288.25 / $4,570.88
| Professional | | $1,000.00 | $1,288.25 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $229.09 / $234.42 / $245.47
| Professional | 26 | $229.09 | $234.42 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,000.00 / $1,047.13 / $1,047.13
| Professional | TC | $1,000.00 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,071.52 / $1,258.93
| Professional | | $1,000.00 | $1,071.52 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $134.90 / $147.91 / $169.82
| Professional | 26 | $134.90 | $147.91 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $851.14 / $933.25 / $1,096.48
| Professional | TC | $851.14 | $933.25 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $977.24 / $1,995.26
| Professional | | $85.11 | $977.24 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $204.17 / $446.68
| Professional | 26 | $109.65 | $204.17 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $602.56 / $954.99 / $1,548.82
| Professional | TC | $602.56 | $954.99 | $1,548.82 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $1,047.13 / $1,698.24
| Professional | | $630.96 | $1,047.13 | $1,698.24 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $138.04 / $194.98
| Professional | 26 | $83.18 | $138.04 | $194.98 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $549.54 / $851.14 / $977.24
| Professional | TC | $549.54 | $851.14 | $977.24 |