- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $40.74 / $47.86
| Facility | 26 | $35.48 | $40.74 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $154.88 / $380.19
| Professional | | $123.03 | $154.88 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $38.90 / $93.33
| Professional | 26 | $28.84 | $38.90 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $117.49 / $245.47
| Professional | TC | $93.33 | $117.49 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $181.97 / $331.13
| Professional | | $114.82 | $181.97 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $46.77 / $79.43
| Professional | 26 | $28.84 | $46.77 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $141.25 / $257.04
| Professional | TC | $85.11 | $141.25 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $218.78 / $234.42
| Professional | | $54.95 | $218.78 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $46.77 / $48.98
| Professional | 26 | $45.71 | $46.77 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $173.78 / $186.21
| Professional | TC | $165.96 | $173.78 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $190.55 / $223.87
| Professional | | $173.78 | $190.55 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $42.66 / $48.98
| Professional | 26 | $38.90 | $42.66 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $134.90 / $147.91 / $173.78
| Professional | TC | $134.90 | $147.91 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $177.83 / $316.23
| Professional | | $141.25 | $177.83 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $47.86 / $295.12
| Professional | 26 | $35.48 | $47.86 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $109.65 / $134.90 / $239.88
| Professional | TC | $109.65 | $134.90 | $239.88 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $239.88 / $416.87
| Professional | | $186.21 | $239.88 | $416.87 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $53.70 / $91.20
| Professional | 26 | $40.74 | $53.70 | $91.20 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $134.90 / $186.21 / $323.59
| Professional | TC | $134.90 | $186.21 | $323.59 |