- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $95.50 / $112.20
| Facility | 26 | $85.11 | $95.50 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $478.63 / $1,174.90
| Professional | | $363.08 | $478.63 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $125.89 / $457.09
| Professional | 26 | $85.11 | $125.89 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $338.84 / $870.96
| Professional | TC | $263.03 | $338.84 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $676.08 / $1,071.52
| Professional | | $354.81 | $676.08 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $104.71 / $162.18
| Professional | 26 | $72.44 | $104.71 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $602.56 / $891.25
| Professional | TC | $263.03 | $602.56 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,412.54 / $1,621.81
| Professional | | $1,000.00 | $1,412.54 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $114.82 / $120.23
| Professional | 26 | $112.20 | $114.82 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,122.02 / $1,122.02 / $1,174.90
| Professional | TC | $1,122.02 | $1,122.02 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $457.09 / $537.03
| Professional | | $389.05 | $457.09 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $100.00 / $117.49
| Professional | 26 | $87.10 | $100.00 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $354.81 / $416.87
| Professional | TC | $302.00 | $354.81 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $891.25 / $2,344.23
| Professional | | $416.87 | $891.25 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $134.90 / $707.95
| Professional | 26 | $87.10 | $134.90 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $316.23 / $660.69 / $1,862.09
| Professional | TC | $316.23 | $660.69 | $1,862.09 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $977.24 / $1,479.11
| Professional | | $489.78 | $977.24 | $1,479.11 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $123.03 / $190.55
| Professional | 26 | $95.50 | $123.03 | $190.55 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $389.05 / $831.76 / $1,288.25
| Professional | TC | $389.05 | $831.76 | $1,288.25 |