- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $67.61 / $79.43
| Facility | 26 | $60.26 | $67.61 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $302.00 / $794.33
| Professional | | $213.80 | $302.00 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $83.18 / $257.04
| Professional | 26 | $52.48 | $83.18 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $218.78 / $478.63
| Professional | TC | $158.49 | $218.78 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $338.84 / $446.68
| Professional | | $234.42 | $338.84 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $74.13 / $114.82
| Professional | 26 | $51.29 | $74.13 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $269.15 / $354.81
| Professional | TC | $169.82 | $269.15 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $446.68 / $501.19
| Professional | | $97.72 | $446.68 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $81.28 / $85.11
| Professional | 26 | $79.43 | $81.28 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $346.74 / $346.74 / $363.08
| Professional | TC | $346.74 | $346.74 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $302.00 / $380.19
| Professional | | $263.03 | $302.00 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $70.79 / $89.13
| Professional | 26 | $61.66 | $70.79 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $234.42 / $295.12
| Professional | TC | $199.53 | $234.42 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $416.87 / $741.31
| Professional | | $85.11 | $416.87 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $87.10 / $501.19
| Professional | 26 | $69.18 | $87.10 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $371.54 / $588.84
| Professional | TC | $190.55 | $371.54 | $588.84 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $407.38 / $707.95
| Professional | | $331.13 | $407.38 | $707.95 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $91.20 / $134.90
| Professional | 26 | $67.61 | $91.20 | $134.90 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $316.23 / $575.44
| Professional | TC | $257.04 | $316.23 | $575.44 |