- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $79.43 / $93.33
| Facility | 26 | $69.18 | $79.43 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $371.54 / $912.01
| Professional | | $208.93 | $371.54 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $112.20 / $346.74
| Professional | 26 | $69.18 | $112.20 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $97.72 / $97.72 / $112.20
| Professional | 52 | $97.72 | $97.72 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $257.04 / $549.54
| Professional | TC | $141.25 | $257.04 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $398.11 / $588.84
| Professional | | $204.17 | $398.11 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $87.10 / $134.90
| Professional | 26 | $58.88 | $87.10 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $128.82 / $263.03 / $512.86
| Professional | TC | $128.82 | $263.03 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $741.31 / $812.83
| Professional | | $501.19 | $741.31 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $95.50 / $100.00
| Professional | 26 | $93.33 | $95.50 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $575.44 / $575.44 / $602.56
| Professional | TC | $575.44 | $575.44 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $257.04 / $302.00
| Professional | | $218.78 | $257.04 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $83.18 / $97.72
| Professional | 26 | $70.79 | $83.18 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $173.78 / $204.17
| Professional | TC | $147.91 | $173.78 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $741.31 / $1,548.82
| Professional | | $234.42 | $741.31 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $93.33 / $457.09
| Professional | 26 | $81.28 | $93.33 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $309.03 / $1,096.48
| Professional | TC | $154.88 | $309.03 | $1,096.48 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $524.81 / $851.14
| Professional | | $275.42 | $524.81 | $851.14 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $104.71 / $154.88
| Professional | 26 | $79.43 | $104.71 | $154.88 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $407.38 / $724.44
| Professional | TC | $186.21 | $407.38 | $724.44 |