- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $173.78 / $204.17
| Facility | | $154.88 | $173.78 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $89.13 / $104.71
| Facility | 26 | $77.62 | $89.13 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $151.36 / $416.87
| Professional | | $125.89 | $151.36 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $79.43 / $239.88
| Professional | 26 | $45.71 | $79.43 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $57.54 / $83.18 / $229.09
| Professional | TC | $57.54 | $83.18 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $281.84 / $562.34
| Professional | | $154.88 | $281.84 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $70.79 / $114.82
| Professional | 26 | $53.70 | $70.79 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $181.97 / $501.19
| Professional | TC | $66.07 | $181.97 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $831.76 / $13,182.57
| Professional | | $660.69 | $831.76 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $107.15 / $112.20
| Professional | 26 | $104.71 | $107.15 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $645.65 / $645.65 / $676.08
| Professional | TC | $645.65 | $645.65 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $190.55 / $218.78
| Professional | | $173.78 | $190.55 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $95.50 / $112.20
| Professional | 26 | $87.10 | $95.50 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $93.33 / $109.65
| Professional | TC | $85.11 | $93.33 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $269.15 / $562.34
| Professional | | $165.96 | $269.15 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $87.10 / $537.03
| Professional | 26 | $72.44 | $87.10 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $158.49 / $426.58
| Professional | TC | $81.28 | $158.49 | $426.58 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $263.03 / $812.83
| Professional | | $194.98 | $263.03 | $812.83 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $107.15 / $141.25
| Professional | 26 | $61.66 | $107.15 | $141.25 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $190.55 / $724.44
| Professional | TC | $97.72 | $190.55 | $724.44 |