- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $10.72 / $12.59
| Facility | 26 | $9.33 | $10.72 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $38.02 / $107.15
| Professional | | $22.91 | $38.02 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $10.96 / $33.11
| Professional | 26 | $7.08 | $10.96 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $23.99 / $60.26
| Professional | TC | $15.85 | $23.99 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $39.81 / $53.70
| Professional | | $26.92 | $39.81 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $11.75 / $18.62
| Professional | 26 | $8.13 | $11.75 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $27.54 / $39.81
| Professional | TC | $19.05 | $27.54 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $48.98 / $50.12
| Professional | | $30.90 | $48.98 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $12.88 / $13.49
| Professional | 26 | $12.59 | $12.88 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $36.31
| Professional | TC | $34.67 | $34.67 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $43.65 / $51.29
| Professional | | $39.81 | $43.65 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $11.48 / $13.49
| Professional | 26 | $10.47 | $11.48 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $32.36 / $37.15
| Professional | TC | $29.51 | $32.36 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $47.86 / $218.78
| Professional | | $38.90 | $47.86 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $16.22 / $87.10
| Professional | 26 | $10.96 | $16.22 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $32.36 / $50.12
| Professional | TC | $23.44 | $32.36 | $50.12 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $53.70 / $75.86
| Professional | | $38.02 | $53.70 | $75.86 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $14.45 / $21.38
| Professional | 26 | $10.96 | $14.45 | $21.38 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $38.90 / $52.48
| Professional | TC | $27.54 | $38.90 | $52.48 |