- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $67.61 / $79.43
| Facility | 26 | $60.26 | $67.61 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $275.42 / $630.96
| Professional | | $169.82 | $275.42 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $64.57 / $141.25
| Professional | 26 | $51.29 | $64.57 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $120.23 / $173.78 / $407.38
| Professional | TC | $120.23 | $173.78 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $309.03 / $436.52
| Professional | | $190.55 | $309.03 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $79.43 / $114.82
| Professional | 26 | $56.23 | $79.43 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $234.42 / $354.81
| Professional | TC | $125.89 | $234.42 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $467.74 / $512.86
| Professional | | $302.00 | $467.74 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $91.20 / $95.50
| Professional | 26 | $89.13 | $91.20 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $363.08 / $363.08 / $380.19
| Professional | TC | $363.08 | $363.08 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $239.88 / $302.00
| Professional | | $208.93 | $239.88 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $70.79 / $89.13
| Professional | 26 | $61.66 | $70.79 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $169.82 / $213.80
| Professional | TC | $147.91 | $169.82 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $416.87 / $933.25
| Professional | | $181.97 | $416.87 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $89.13 / $489.78
| Professional | 26 | $69.18 | $89.13 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $281.84 / $691.83
| Professional | TC | $151.36 | $281.84 | $691.83 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $407.38 / $758.58
| Professional | | $263.03 | $407.38 | $758.58 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $93.33 / $144.54
| Professional | 26 | $72.44 | $93.33 | $144.54 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $323.59 / $630.96
| Professional | TC | $186.21 | $323.59 | $630.96 |