- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $12.59 / $14.79
| Facility | 26 | $11.22 | $12.59 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $52.48 / $346.74
| Facility | TC | $40.74 | $52.48 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $54.95 / $213.80
| Professional | | $25.12 | $54.95 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $15.85 / $58.88
| Professional | 26 | $8.91 | $15.85 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $66.07 / $251.19 / $281.84
| Professional | 50 | $66.07 | $251.19 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $41.69 / $91.20
| Professional | TC | $23.99 | $41.69 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $53.70 / $77.62
| Professional | | $34.67 | $53.70 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $13.49 / $20.42
| Professional | 26 | $9.77 | $13.49 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $35.48 / $60.26
| Professional | TC | $24.55 | $35.48 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $69.18 / $72.44
| Professional | | $52.48 | $69.18 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $14.79 / $15.49
| Professional | 26 | $14.45 | $14.79 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $51.29 / $53.70 / $61.66
| Professional | TC | $51.29 | $53.70 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $66.07 / $77.62
| Professional | | $60.26 | $66.07 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $13.80 / $15.85
| Professional | 26 | $12.59 | $13.80 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $52.48 / $60.26
| Professional | TC | $47.86 | $52.48 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $69.18 / $331.13
| Professional | | $50.12 | $69.18 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $17.78 / $87.10
| Professional | 26 | $12.88 | $17.78 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $42.66 / $74.13
| Professional | TC | $35.48 | $42.66 | $74.13 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $74.13 / $89.13
| Professional | | $46.77 | $74.13 | $89.13 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $16.22 / $23.99
| Professional | 26 | $12.88 | $16.22 | $23.99 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $54.95 / $67.61
| Professional | TC | $35.48 | $54.95 | $67.61 |