- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $51.29 / $66.07
| Professional | | $36.31 | $51.29 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $19.05 / $25.70
| Professional | 26 | $15.85 | $19.05 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $25.12 / $47.86
| Professional | TC | $19.05 | $25.12 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $42.66 / $70.79
| Professional | | $31.62 | $42.66 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $19.50 / $25.70
| Professional | 26 | $13.49 | $19.50 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $23.44 / $36.31
| Professional | TC | $18.62 | $23.44 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $58.88 / $89.13
| Professional | | $34.67 | $58.88 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $30.20 / $31.62
| Professional | 26 | $28.84 | $30.20 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $50.12 / $56.23
| Professional | TC | $47.86 | $50.12 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $57.54 / $77.62
| Professional | | $57.54 | $57.54 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $23.44 / $31.62
| Professional | 26 | $23.44 | $23.44 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $33.88 / $45.71
| Professional | TC | $33.88 | $33.88 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $51.29 / $70.79
| Professional | | $33.11 | $51.29 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $21.38 / $33.11
| Professional | 26 | $15.14 | $21.38 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $29.51 / $41.69
| Professional | TC | $17.38 | $29.51 | $41.69 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $58.88 / $67.61
| Professional | | $36.31 | $58.88 | $67.61 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $24.55 / $26.92
| Professional | 26 | $15.14 | $24.55 | $26.92 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $33.88 / $41.69
| Professional | TC | $20.89 | $33.88 | $41.69 |