- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $63.10 / $117.49
| Professional | | $53.70 | $63.10 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $28.84 / $61.66
| Professional | 26 | $23.99 | $28.84 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $33.88 / $51.29
| Professional | TC | $28.84 | $33.88 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $77.62 / $257.04
| Professional | | $63.10 | $77.62 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $34.67 / $72.44
| Professional | 26 | $27.54 | $34.67 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $42.66 / $158.49
| Professional | TC | $33.11 | $42.66 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $245.47 / $295.12
| Professional | | $44.67 | $245.47 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $38.02 / $38.90
| Professional | 26 | $36.31 | $38.02 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $218.78 / $218.78
| Professional | TC | $208.93 | $218.78 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $91.20 / $114.82
| Professional | | $75.86 | $91.20 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $35.48 / $43.65
| Professional | 26 | $29.51 | $35.48 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $56.23 / $69.18
| Professional | TC | $46.77 | $56.23 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $74.13 / $128.82
| Professional | | $52.48 | $74.13 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $33.88 / $53.70
| Professional | 26 | $25.12 | $33.88 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $40.74 / $63.10
| Professional | TC | $26.92 | $40.74 | $63.10 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $77.62 / $134.90
| Professional | | $58.88 | $77.62 | $134.90 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $33.11 / $54.95
| Professional | 26 | $25.12 | $33.11 | $54.95 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $44.67 / $75.86
| Professional | TC | $33.11 | $44.67 | $75.86 |