- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $114.82 / $134.90
| Facility | 26 | $102.33 | $114.82 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $512.86 / $1,096.48
| Professional | | $371.54 | $512.86 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $141.25 / $537.03
| Professional | 26 | $102.33 | $141.25 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $338.84 / $870.96
| Professional | TC | $251.19 | $338.84 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $562.34 / $891.25
| Professional | | $346.74 | $562.34 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $125.89 / $194.98
| Professional | 26 | $85.11 | $125.89 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $239.88 / $467.74 / $758.58
| Professional | TC | $239.88 | $467.74 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,621.81 / $1,778.28
| Professional | | $1,174.90 | $1,621.81 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $134.90 / $141.25
| Professional | 26 | $131.83 | $134.90 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,258.93 / $1,258.93 / $1,318.26
| Professional | TC | $1,258.93 | $1,258.93 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $446.68 / $524.81
| Professional | | $380.19 | $446.68 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $120.23 / $141.25
| Professional | 26 | $104.71 | $120.23 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $275.42 / $323.59 / $380.19
| Professional | TC | $275.42 | $323.59 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $776.25 / $1,659.59
| Professional | | $338.84 | $776.25 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $162.18 / $831.76
| Professional | 26 | $87.10 | $162.18 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $288.40 / $575.44 / $1,412.54
| Professional | TC | $288.40 | $575.44 | $1,412.54 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $794.33 / $1,513.56
| Professional | | $478.63 | $794.33 | $1,513.56 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $147.91 / $223.87
| Professional | 26 | $109.65 | $147.91 | $223.87 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $354.81 / $676.08 / $1,380.38
| Professional | TC | $354.81 | $676.08 | $1,380.38 |