- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $33.88 / $120.23
| Professional | | $28.18 | $33.88 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $12.88 / $53.70
| Professional | 26 | $10.00 | $12.88 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $21.88 / $39.81
| Professional | TC | $18.20 | $21.88 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $42.66 / $61.66
| Professional | | $30.90 | $42.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $16.22 / $23.44
| Professional | 26 | $11.48 | $16.22 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $27.54 / $38.02
| Professional | TC | $19.95 | $27.54 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $42.66 / $50.12
| Professional | | $29.51 | $42.66 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $19.05 / $19.95
| Professional | 26 | $18.62 | $19.05 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $30.90 / $32.36
| Professional | TC | $29.51 | $30.90 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $44.67 / $52.48
| Professional | | $40.74 | $44.67 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $13.80 / $15.85
| Professional | 26 | $12.59 | $13.80 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $30.90 / $36.31
| Professional | TC | $28.18 | $30.90 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $43.65 / $83.18
| Professional | | $29.51 | $43.65 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $18.62 / $33.88
| Professional | 26 | $10.23 | $18.62 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $26.92 / $50.12
| Professional | TC | $19.50 | $26.92 | $50.12 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $47.86 / $158.49
| Professional | | $28.84 | $47.86 | $158.49 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $12.88 / $17.38
| Professional | 26 | $10.47 | $12.88 | $17.38 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $22.91 / $30.90
| Professional | TC | $18.62 | $22.91 | $30.90 |