- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $16.60 / $19.50
| Facility | 26 | $14.79 | $16.60 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $75.86 / $194.98
| Professional | | $50.12 | $75.86 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $18.20 / $46.77
| Professional | 26 | $12.02 | $18.20 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $50.12 / $117.49
| Professional | TC | $36.31 | $50.12 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $85.11 / $107.15
| Professional | | $56.23 | $85.11 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $19.95 / $30.20
| Professional | 26 | $14.13 | $19.95 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $63.10 / $79.43
| Professional | TC | $42.66 | $63.10 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $91.20 / $95.50
| Professional | | $60.26 | $91.20 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $23.44 / $24.55
| Professional | 26 | $22.91 | $23.44 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $70.79
| Professional | TC | $67.61 | $67.61 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $81.28 / $95.50
| Professional | | $75.86 | $81.28 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $17.38 / $20.42
| Professional | 26 | $16.22 | $17.38 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $64.57 / $75.86
| Professional | TC | $58.88 | $64.57 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $91.20 / $407.38
| Professional | | $58.88 | $91.20 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $24.55 / $93.33
| Professional | 26 | $16.60 | $24.55 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $45.71 / $67.61 / $114.82
| Professional | TC | $45.71 | $67.61 | $114.82 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $100.00 / $147.91
| Professional | | $75.86 | $100.00 | $147.91 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $25.12 / $37.15
| Professional | 26 | $17.78 | $25.12 | $37.15 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $75.86 / $114.82
| Professional | TC | $54.95 | $75.86 | $114.82 |