- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $114.82 / $158.49
| Professional | | $91.20 | $114.82 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $15.14 / $18.20
| Professional | 26 | $12.02 | $15.14 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $100.00 / $138.04
| Professional | TC | $79.43 | $100.00 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $117.49 / $181.97
| Professional | | $81.28 | $117.49 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $14.45 / $18.62
| Professional | 26 | $11.75 | $14.45 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $69.18 / $102.33 / $162.18
| Professional | TC | $69.18 | $102.33 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $169.82 / $177.83
| Professional | | $125.89 | $169.82 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $20.89 / $21.38
| Professional | 26 | $19.95 | $20.89 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $154.88
| Professional | TC | $147.91 | $147.91 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $229.09
| Professional | | $165.96 | $165.96 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $16.60 / $22.91
| Professional | 26 | $16.60 | $16.60 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $204.17
| Professional | TC | $147.91 | $147.91 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $125.89 / $181.97
| Professional | | $31.62 | $125.89 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $15.85 / $21.88
| Professional | 26 | $10.72 | $15.85 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $45.71 / $123.03 / $162.18
| Professional | TC | $45.71 | $123.03 | $162.18 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $109.65 / $169.82
| Professional | | $89.13 | $109.65 | $169.82 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $16.98 / $23.44
| Professional | 26 | $11.22 | $16.98 | $23.44 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $95.50 / $147.91
| Professional | TC | $72.44 | $95.50 | $147.91 |