- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $57.54 / $67.61
| Facility | 26 | $51.29 | $57.54 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $208.93 / $616.60
| Professional | | $128.82 | $208.93 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $70.79 / $194.98
| Professional | 26 | $47.86 | $70.79 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $114.82 / $309.03
| Professional | TC | $79.43 | $114.82 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $213.80 / $295.12
| Professional | | $138.04 | $213.80 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $63.10 / $100.00
| Professional | 26 | $43.65 | $63.10 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $147.91 / $223.87
| Professional | TC | $83.18 | $147.91 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $389.05 / $426.58
| Professional | | $269.15 | $389.05 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $69.18 / $72.44
| Professional | 26 | $67.61 | $69.18 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $316.23
| Professional | TC | $302.00 | $302.00 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $173.78 / $218.78
| Professional | | $147.91 | $173.78 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $60.26 / $75.86
| Professional | 26 | $52.48 | $60.26 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $112.20 / $141.25
| Professional | TC | $97.72 | $112.20 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $295.12 / $891.25
| Professional | | $131.83 | $295.12 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $85.11 / $426.58
| Professional | 26 | $60.26 | $85.11 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $181.97 / $416.87
| Professional | TC | $100.00 | $181.97 | $416.87 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $275.42 / $501.19
| Professional | | $186.21 | $275.42 | $501.19 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $77.62 / $114.82
| Professional | 26 | $57.54 | $77.62 | $114.82 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $120.23 / $213.80 / $398.11
| Professional | TC | $120.23 | $213.80 | $398.11 |