- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $102.33 / $173.78
| Professional | | $85.11 | $102.33 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $63.10 / $147.91
| Professional | 26 | $51.29 | $63.10 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $41.69 / $83.18
| Professional | TC | $23.99 | $41.69 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $107.15 / $162.18
| Professional | | $69.18 | $107.15 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $67.61 / $93.33
| Professional | 26 | $46.77 | $67.61 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $45.71 / $67.61
| Professional | TC | $18.62 | $45.71 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $66.07 / $131.83
| Professional | | $52.48 | $66.07 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $77.62 / $79.43
| Professional | 26 | $74.13 | $77.62 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $51.29 / $53.70 / $53.70
| Professional | TC | $51.29 | $53.70 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $120.23 / $144.54
| Professional | | $104.71 | $120.23 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $64.57 / $77.62
| Professional | 26 | $56.23 | $64.57 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $54.95 / $66.07
| Professional | TC | $47.86 | $54.95 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $117.49 / $616.60
| Professional | | $87.10 | $117.49 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $66.07 / $93.33
| Professional | 26 | $56.23 | $66.07 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $38.90 / $66.07
| Professional | TC | $25.70 | $38.90 | $66.07 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $128.82 / $208.93
| Professional | | $77.62 | $128.82 | $208.93 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $67.61 / $123.03
| Professional | 26 | $48.98 | $67.61 | $123.03 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $52.48 / $67.61
| Professional | TC | $31.62 | $52.48 | $67.61 |