- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $199.53 / $478.63
| Professional | | $138.04 | $199.53 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $61.66 / $177.83
| Professional | 26 | $36.31 | $61.66 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $102.33 / $141.25 / $275.42
| Professional | TC | $102.33 | $141.25 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $229.09 / $389.05
| Professional | | $158.49 | $229.09 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $54.95 / $97.72
| Professional | 26 | $38.02 | $54.95 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $117.49 / $169.82 / $295.12
| Professional | TC | $117.49 | $169.82 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $239.88 / $269.15
| Professional | | $169.82 | $239.88 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $79.43 / $81.28
| Professional | 26 | $75.86 | $79.43 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $177.83 / $194.98
| Professional | TC | $169.82 | $177.83 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $190.55 / $223.87
| Professional | | $173.78 | $190.55 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $44.67 / $52.48
| Professional | 26 | $41.69 | $44.67 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $131.83 / $144.54 / $169.82
| Professional | TC | $131.83 | $144.54 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $229.09 / $478.63
| Professional | | $125.89 | $229.09 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $61.66 / $316.23
| Professional | 26 | $36.31 | $61.66 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $173.78 / $331.13
| Professional | TC | $100.00 | $173.78 | $331.13 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $208.93 / $407.38
| Professional | | $141.25 | $208.93 | $407.38 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $50.12 / $95.50
| Professional | 26 | $33.88 | $50.12 | $95.50 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $107.15 / $151.36 / $316.23
| Professional | TC | $107.15 | $151.36 | $316.23 |