- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $34.67 / $40.74
| Facility | 26 | $30.90 | $34.67 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $120.23 / $275.42
| Professional | | $70.79 | $120.23 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $50.12 / $128.82
| Professional | 26 | $27.54 | $50.12 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $64.57 / $125.89
| Professional | TC | $41.69 | $64.57 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $112.20 / $181.97
| Professional | | $63.10 | $112.20 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $38.90 / $69.18
| Professional | 26 | $24.55 | $38.90 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.02 / $69.18 / $112.20
| Professional | TC | $38.02 | $69.18 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $102.33 / $117.49
| Professional | | $64.57 | $102.33 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $41.69 / $43.65
| Professional | 26 | $40.74 | $41.69 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $75.86
| Professional | TC | $72.44 | $72.44 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $107.15 / $123.03
| Professional | | $97.72 | $107.15 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $37.15 / $43.65
| Professional | 26 | $34.67 | $37.15 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $69.18 / $81.28
| Professional | TC | $63.10 | $69.18 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $117.49 / $645.65
| Professional | | $77.62 | $117.49 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $50.12 / $251.19
| Professional | 26 | $30.90 | $50.12 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $75.86 / $104.71
| Professional | TC | $48.98 | $75.86 | $104.71 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $131.83 / $194.98
| Professional | | $97.72 | $131.83 | $194.98 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $45.71 / $69.18
| Professional | 26 | $30.90 | $45.71 | $69.18 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $85.11 / $131.83
| Professional | TC | $66.07 | $85.11 | $131.83 |