- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,148.15 / $1,995.26
| Professional | | $977.24 | $1,148.15 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $269.15 / $316.23 / $870.96
| Professional | 26 | $269.15 | $316.23 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $707.95 / $812.83 / $1,412.54
| Professional | TC | $707.95 | $812.83 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,318.26 / $1,995.26
| Professional | | $1,230.27 | $1,318.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $338.84 / $380.19 / $512.86
| Professional | 26 | $338.84 | $380.19 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $831.76 / $977.24 / $1,479.11
| Professional | TC | $831.76 | $977.24 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $9,772.37 / $15,135.61
| Professional | | $416.87 | $9,772.37 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,318.26 / $1,548.82
| Professional | | $1,202.26 | $1,318.26 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $309.03 / $338.84 / $398.11
| Professional | 26 | $309.03 | $338.84 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $912.01 / $977.24 / $1,148.15
| Professional | TC | $912.01 | $977.24 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,513.56 / $1,819.70
| Professional | | $1,071.52 | $1,513.56 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $275.42 / $457.09 / $467.74
| Professional | 26 | $275.42 | $457.09 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $794.33 / $1,071.52 / $1,348.96
| Professional | TC | $794.33 | $1,071.52 | $1,348.96 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $10,715.19 / $15,135.61
| Professional | | $1,230.27 | $10,715.19 | $15,135.61 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $208.93 / $338.84 / $371.54
| Professional | 26 | $208.93 | $338.84 | $371.54 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $645.65 / $1,023.29 / $1,148.15
| Professional | TC | $645.65 | $1,023.29 | $1,148.15 |