- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $9.55 / $11.22
| Facility | 26 | $8.32 | $9.55 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $44.67 / $125.89
| Professional | | $25.70 | $44.67 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $10.96 / $40.74
| Professional | 26 | $6.03 | $10.96 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $28.84 / $74.13
| Professional | TC | $19.05 | $28.84 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $38.90 / $61.66
| Professional | | $28.18 | $38.90 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $10.47 / $15.85
| Professional | 26 | $6.92 | $10.47 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $28.84 / $48.98
| Professional | TC | $19.95 | $28.84 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $56.23 / $60.26
| Professional | | $38.02 | $56.23 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $10.96 / $11.48
| Professional | 26 | $10.72 | $10.96 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $44.67 / $51.29
| Professional | TC | $42.66 | $44.67 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $50.12 / $57.54
| Professional | | $45.71 | $50.12 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $10.23 / $12.02
| Professional | 26 | $9.33 | $10.23 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $39.81 / $45.71
| Professional | TC | $36.31 | $39.81 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $48.98 / $239.88
| Professional | | $36.31 | $48.98 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $12.30 / $52.48
| Professional | 26 | $7.76 | $12.30 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $43.65 / $194.98
| Professional | TC | $29.51 | $43.65 | $194.98 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $58.88 / $74.13
| Professional | | $37.15 | $58.88 | $74.13 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $12.59 / $18.62
| Professional | 26 | $9.33 | $12.59 | $18.62 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $44.67 / $56.23
| Professional | TC | $29.51 | $44.67 | $56.23 |