- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $467.74 / $891.25
| Professional | | $380.19 | $467.74 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $69.18 / $169.82
| Professional | 26 | $52.48 | $69.18 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $331.13 / $389.05 / $758.58
| Professional | TC | $331.13 | $389.05 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $602.56 / $794.33
| Professional | | $512.86 | $602.56 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $74.13 / $107.15
| Professional | 26 | $60.26 | $74.13 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $457.09 / $524.81 / $691.83
| Professional | TC | $457.09 | $524.81 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $1,023.29 / $1,174.90
| Professional | | $144.54 | $1,023.29 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $125.89 / $131.83
| Professional | 26 | $117.49 | $125.89 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $851.14 / $851.14 / $891.25
| Professional | TC | $851.14 | $851.14 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $645.65 / $812.83
| Professional | | $588.84 | $645.65 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $70.79 / $89.13
| Professional | 26 | $66.07 | $70.79 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $524.81 / $575.44 / $707.95
| Professional | TC | $524.81 | $575.44 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $549.54 / $707.95
| Professional | | $416.87 | $549.54 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $69.18 / $114.82
| Professional | 26 | $53.70 | $69.18 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $363.08 / $478.63 / $616.60
| Professional | TC | $363.08 | $478.63 | $616.60 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $588.84 / $794.33
| Professional | | $407.38 | $588.84 | $794.33 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $74.13 / $87.10
| Professional | 26 | $51.29 | $74.13 | $87.10 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $354.81 / $524.81 / $691.83
| Professional | TC | $354.81 | $524.81 | $691.83 |