- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $81.28 / $144.54
| Professional | | $69.18 | $81.28 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $46.77 / $109.65
| Professional | 26 | $37.15 | $46.77 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $38.90 / $75.86
| Professional | TC | $20.89 | $38.90 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $87.10 / $131.83
| Professional | | $53.70 | $87.10 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $48.98 / $70.79
| Professional | 26 | $33.88 | $48.98 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $40.74 / $61.66
| Professional | TC | $16.60 | $40.74 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $60.26 / $112.20
| Professional | | $48.98 | $60.26 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $63.10 / $64.57
| Professional | 26 | $60.26 | $63.10 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $48.98 / $48.98
| Professional | TC | $46.77 | $48.98 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $97.72 / $117.49
| Professional | | $85.11 | $97.72 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $47.86 / $58.88
| Professional | 26 | $41.69 | $47.86 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $50.12 / $60.26
| Professional | TC | $42.66 | $50.12 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $97.72 / $120.23
| Professional | | $69.18 | $97.72 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $50.12 / $323.59
| Professional | 26 | $40.74 | $50.12 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $35.48 / $60.26
| Professional | TC | $21.88 | $35.48 | $60.26 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $93.33 / $165.96
| Professional | | $64.57 | $93.33 | $165.96 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $50.12 / $83.18
| Professional | 26 | $36.31 | $50.12 | $83.18 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $45.71 / $57.54
| Professional | TC | $27.54 | $45.71 | $57.54 |