- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $93.33 / $109.65
| Facility | 26 | $81.28 | $93.33 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $275.42 / $602.56
| Professional | | $218.78 | $275.42 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $91.20 / $338.84
| Professional | 26 | $67.61 | $91.20 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $138.04 / $190.55 / $371.54
| Professional | TC | $138.04 | $190.55 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $288.40 / $489.78
| Professional | | $234.42 | $288.40 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $97.72 / $158.49
| Professional | 26 | $67.61 | $97.72 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $194.98 / $371.54
| Professional | TC | $147.91 | $194.98 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $323.59 / $354.81
| Professional | | $199.53 | $323.59 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $109.65 / $114.82
| Professional | 26 | $107.15 | $109.65 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $234.42 / $263.03
| Professional | TC | $223.87 | $234.42 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $302.00 / $380.19
| Professional | | $257.04 | $302.00 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $97.72 / $123.03
| Professional | 26 | $85.11 | $97.72 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $204.17 / $251.19
| Professional | TC | $173.78 | $204.17 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $416.87 / $691.83
| Professional | | $234.42 | $416.87 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $114.82 / $676.08
| Professional | 26 | $87.10 | $114.82 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $302.00 / $501.19
| Professional | TC | $173.78 | $302.00 | $501.19 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $380.19 / $691.83
| Professional | | $316.23 | $380.19 | $691.83 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $123.03 / $208.93
| Professional | 26 | $91.20 | $123.03 | $208.93 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $275.42 / $467.74
| Professional | TC | $213.80 | $275.42 | $467.74 |