- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $14.79 / $17.38
| Facility | 26 | $13.18 | $14.79 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $72.44 / $218.78
| Professional | | $42.66 | $72.44 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $19.05 / $56.23
| Professional | 26 | $10.96 | $19.05 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $41.69 / $104.71
| Professional | TC | $25.70 | $41.69 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $67.61 / $87.10
| Professional | | $45.71 | $67.61 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $17.38 / $28.84
| Professional | 26 | $12.88 | $17.38 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $44.67 / $61.66
| Professional | TC | $33.11 | $44.67 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $79.43 / $81.28
| Professional | | $58.88 | $79.43 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $20.42 / $21.38
| Professional | 26 | $19.95 | $20.42 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $57.54 / $57.54 / $60.26
| Professional | TC | $57.54 | $57.54 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $72.44 / $85.11
| Professional | | $67.61 | $72.44 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $15.85 / $18.62
| Professional | 26 | $14.45 | $15.85 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $57.54 / $66.07
| Professional | TC | $52.48 | $57.54 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $74.13 / $263.03
| Professional | | $63.10 | $74.13 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $24.55 / $95.50
| Professional | 26 | $14.79 | $24.55 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $61.66 / $275.42
| Professional | TC | $42.66 | $61.66 | $275.42 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $87.10 / $109.65
| Professional | | $58.88 | $87.10 | $109.65 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $20.42 / $33.11
| Professional | 26 | $16.22 | $20.42 | $33.11 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $67.61 / $79.43
| Professional | TC | $41.69 | $67.61 | $79.43 |