- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $426.58 / $912.01
| Professional | | $194.98 | $426.58 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $63.10 / $138.04
| Professional | 26 | $51.29 | $63.10 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $338.84 / $660.69
| Professional | TC | $251.19 | $338.84 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $457.09 / $630.96
| Professional | | $234.42 | $457.09 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $69.18 / $95.50
| Professional | 26 | $60.26 | $69.18 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $398.11 / $549.54
| Professional | TC | $162.18 | $398.11 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $467.74 / $524.81
| Professional | | $87.10 | $467.74 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $75.86 / $77.62
| Professional | 26 | $72.44 | $75.86 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $380.19 / $398.11 / $398.11
| Professional | TC | $380.19 | $398.11 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $562.34 / $691.83
| Professional | | $512.86 | $562.34 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $70.79 / $87.10
| Professional | 26 | $64.57 | $70.79 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $446.68 / $489.78 / $602.56
| Professional | TC | $446.68 | $489.78 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $436.52 / $630.96
| Professional | | $275.42 | $436.52 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $67.61 / $91.20
| Professional | 26 | $53.70 | $67.61 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $380.19 / $457.09
| Professional | TC | $208.93 | $380.19 | $457.09 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $478.63 / $707.95
| Professional | | $181.97 | $478.63 | $707.95 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $64.57 / $75.86
| Professional | 26 | $42.66 | $64.57 | $75.86 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $120.23 / $371.54 / $446.68
| Professional | TC | $120.23 | $371.54 | $446.68 |