- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $30.90 / $36.31
| Facility | 26 | $26.92 | $30.90 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $83.18 / $234.42
| Professional | | $51.29 | $83.18 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $37.15 / $107.15
| Professional | 26 | $23.44 | $37.15 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $57.54 / $229.09 / $489.78
| Professional | 52 | $57.54 | $229.09 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $47.86 / $97.72
| Professional | TC | $25.70 | $47.86 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $83.18 / $190.55
| Professional | | $54.95 | $83.18 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $33.88 / $57.54
| Professional | 26 | $21.88 | $33.88 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $52.48 / $125.89
| Professional | TC | $30.90 | $52.48 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $97.72 / $112.20
| Professional | | $61.66 | $97.72 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $34.67 / $36.31
| Professional | 26 | $33.88 | $34.67 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $69.18 / $72.44 / $79.43
| Professional | TC | $69.18 | $72.44 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $79.43 / $93.33
| Professional | | $72.44 | $79.43 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $33.88 / $39.81
| Professional | 26 | $30.90 | $33.88 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $45.71 / $52.48
| Professional | TC | $41.69 | $45.71 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $95.50 / $190.55
| Professional | | $61.66 | $95.50 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $40.74 / $223.87
| Professional | 26 | $26.92 | $40.74 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $61.66 / $102.33
| Professional | TC | $34.67 | $61.66 | $102.33 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $114.82 / $181.97
| Professional | | $75.86 | $114.82 | $181.97 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $39.81 / $56.23
| Professional | 26 | $28.84 | $39.81 | $56.23 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $77.62 / $128.82
| Professional | TC | $47.86 | $77.62 | $128.82 |