- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $72.44 / $85.11
| Facility | 26 | $64.57 | $72.44 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $363.08 / $1,000.00
| Professional | | $125.89 | $363.08 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $117.49 / $316.23
| Professional | 26 | $64.57 | $117.49 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $281.84 / $616.60
| Professional | TC | $147.91 | $281.84 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $389.05 / $512.86
| Professional | | $208.93 | $389.05 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $81.28 / $123.03
| Professional | 26 | $54.95 | $81.28 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $281.84 / $446.68
| Professional | TC | $141.25 | $281.84 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $707.95 / $831.76
| Professional | | $107.15 | $707.95 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $89.13 / $93.33
| Professional | 26 | $87.10 | $89.13 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $588.84 / $588.84 / $616.60
| Professional | TC | $588.84 | $588.84 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $269.15 / $316.23
| Professional | | $229.09 | $269.15 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $77.62 / $89.13
| Professional | 26 | $66.07 | $77.62 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $194.98 / $223.87
| Professional | TC | $165.96 | $194.98 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $524.81 / $1,348.96
| Professional | | $251.19 | $524.81 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $95.50 / $489.78
| Professional | 26 | $74.13 | $95.50 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $323.59 / $1,230.27
| Professional | TC | $169.82 | $323.59 | $1,230.27 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $562.34 / $831.76
| Professional | | $288.40 | $562.34 | $831.76 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $93.33 / $144.54
| Professional | 26 | $69.18 | $93.33 | $144.54 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $446.68 / $707.95
| Professional | TC | $204.17 | $446.68 | $707.95 |