- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $794.33 / $1,819.70
| Professional | | $616.60 | $794.33 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $162.18 / $645.65
| Professional | 26 | $120.23 | $162.18 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $512.86 / $512.86 / $512.86
| Professional | 52 | $512.86 | $512.86 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $501.19 / $660.69 / $1,348.96
| Professional | TC | $501.19 | $660.69 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $912.01 / $1,122.02
| Professional | | $776.25 | $912.01 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $158.49 / $229.09
| Professional | 26 | $128.82 | $158.49 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $645.65 / $741.31 / $891.25
| Professional | TC | $645.65 | $741.31 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $1,174.90 / $1,230.27
| Professional | | $323.59 | $1,174.90 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $234.42 / $269.15 / $281.84
| Professional | 26 | $234.42 | $269.15 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $891.25 / $891.25 / $933.25
| Professional | TC | $891.25 | $891.25 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $954.99 / $1,174.90
| Professional | | $870.96 | $954.99 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $141.25 / $151.36 / $190.55
| Professional | 26 | $141.25 | $151.36 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $724.44 / $794.33 / $1,000.00
| Professional | TC | $724.44 | $794.33 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $831.76 / $1,148.15
| Professional | | $630.96 | $831.76 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $147.91 / $229.09
| Professional | 26 | $117.49 | $147.91 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $512.86 / $691.83 / $933.25
| Professional | TC | $512.86 | $691.83 | $933.25 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $912.01 / $1,148.15
| Professional | | $616.60 | $912.01 | $1,148.15 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $162.18 / $186.21
| Professional | 26 | $109.65 | $162.18 | $186.21 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $512.86 / $758.58 / $870.96
| Professional | TC | $512.86 | $758.58 | $870.96 |