- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $37.15 / $43.65
| Facility | 26 | $33.11 | $37.15 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $165.96 / $436.52
| Professional | | $97.72 | $165.96 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $51.29 / $134.90
| Professional | 26 | $29.51 | $51.29 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $173.78
| Professional | 52 | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $102.33 / $218.78
| Professional | TC | $72.44 | $102.33 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $144.54 / $263.03
| Professional | | $93.33 | $144.54 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $41.69 / $74.13
| Professional | 26 | $26.30 | $41.69 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $104.71 / $186.21
| Professional | TC | $61.66 | $104.71 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $173.78 / $190.55
| Professional | | $120.23 | $173.78 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $44.67 / $46.77
| Professional | 26 | $43.65 | $44.67 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $131.83 / $141.25
| Professional | TC | $125.89 | $131.83 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $154.88 / $181.97
| Professional | | $141.25 | $154.88 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $39.81 / $46.77
| Professional | 26 | $36.31 | $39.81 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $107.15 / $114.82 / $134.90
| Professional | TC | $107.15 | $114.82 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $147.91 / $269.15
| Professional | | $85.11 | $147.91 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $54.95 / $213.80
| Professional | 26 | $35.48 | $54.95 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $104.71 / $602.56
| Professional | TC | $85.11 | $104.71 | $602.56 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $190.55 / $275.42
| Professional | | $134.90 | $190.55 | $275.42 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $50.12 / $72.44
| Professional | 26 | $37.15 | $50.12 | $72.44 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $138.04 / $204.17
| Professional | TC | $89.13 | $138.04 | $204.17 |