- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $97.72 / $114.82
| Facility | 26 | $87.10 | $97.72 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $389.05 / $1,548.82
| Professional | | $281.84 | $389.05 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $107.15 / $354.81
| Professional | 26 | $81.28 | $107.15 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $263.03 / $588.84
| Professional | TC | $190.55 | $263.03 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $389.05 / $549.54
| Professional | | $302.00 | $389.05 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $104.71 / $165.96
| Professional | 26 | $70.79 | $104.71 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $288.40 / $416.87
| Professional | TC | $218.78 | $288.40 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $891.25 / $1,000.00
| Professional | | $616.60 | $891.25 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $151.36 / $154.88 / $162.18
| Professional | 26 | $151.36 | $154.88 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $691.83 / $691.83 / $724.44
| Professional | TC | $691.83 | $691.83 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $398.11 / $501.19
| Professional | | $338.84 | $398.11 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $102.33 / $128.82
| Professional | 26 | $87.10 | $102.33 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $295.12 / $371.54
| Professional | TC | $251.19 | $295.12 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $489.78 / $2,511.89
| Professional | | $85.11 | $489.78 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $138.04 / $707.95
| Professional | 26 | $87.10 | $138.04 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $363.08 / $1,778.28
| Professional | TC | $87.10 | $363.08 | $1,778.28 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $537.03 / $812.83
| Professional | | $407.38 | $537.03 | $812.83 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $128.82 / $218.78
| Professional | 26 | $95.50 | $128.82 | $218.78 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $407.38 / $602.56
| Professional | TC | $302.00 | $407.38 | $602.56 |