- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $11.75 / $13.80
| Facility | 26 | $10.47 | $11.75 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $42.66 / $120.23
| Professional | | $30.20 | $42.66 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $12.02 / $31.62
| Professional | 26 | $8.71 | $12.02 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $28.18 / $66.07
| Professional | TC | $19.05 | $28.18 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $46.77 / $64.57
| Professional | | $33.88 | $46.77 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $13.80 / $22.91
| Professional | 26 | $10.00 | $13.80 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $32.36 / $45.71
| Professional | TC | $23.44 | $32.36 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $56.23 / $58.88
| Professional | | $35.48 | $56.23 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $16.22 / $16.98
| Professional | 26 | $15.85 | $16.22 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $41.69
| Professional | TC | $39.81 | $39.81 | $41.69 |
- 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
- $11.75 / $12.88 / $14.79
| Professional | 26 | $11.75 | $12.88 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $37.15 / $43.65
| Professional | TC | $33.88 | $37.15 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $54.95 / $245.47
| Professional | | $36.31 | $54.95 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $19.05 / $87.10
| Professional | 26 | $12.02 | $19.05 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $40.74 / $190.55
| Professional | TC | $31.62 | $40.74 | $190.55 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $63.10 / $91.20
| Professional | | $47.86 | $63.10 | $91.20 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $16.22 / $26.92
| Professional | 26 | $12.59 | $16.22 | $26.92 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $45.71 / $66.07
| Professional | TC | $33.88 | $45.71 | $66.07 |