- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $53.70 / $77.62
| Professional | | $42.66 | $53.70 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $15.85 / $23.99
| Professional | 26 | $12.88 | $15.85 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $38.02 / $54.95
| Professional | TC | $28.84 | $38.02 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $60.26 / $104.71
| Professional | | $41.69 | $60.26 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $16.98 / $25.12
| Professional | 26 | $12.30 | $16.98 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $38.02 / $70.79
| Professional | TC | $29.51 | $38.02 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $85.11 / $89.13
| Professional | | $57.54 | $85.11 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $22.91 / $23.44
| Professional | 26 | $21.88 | $22.91 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $66.07 / $66.07
| Professional | TC | $63.10 | $66.07 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $50.12 / $60.26
| Professional | | $43.65 | $50.12 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $15.85 / $19.05
| Professional | 26 | $13.49 | $15.85 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $34.67 / $41.69
| Professional | TC | $29.51 | $34.67 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $60.26 / $154.88
| Professional | | $44.67 | $60.26 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $17.38 / $112.20
| Professional | 26 | $13.80 | $17.38 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $42.66 / $63.10
| Professional | TC | $31.62 | $42.66 | $63.10 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $61.66 / $120.23
| Professional | | $45.71 | $61.66 | $120.23 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $17.38 / $31.62
| Professional | 26 | $13.18 | $17.38 | $31.62 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $43.65 / $89.13
| Professional | TC | $33.11 | $43.65 | $89.13 |