- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $37.15 / $43.65
| Facility | 26 | $32.36 | $37.15 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $128.82 / $316.23
| Professional | | $89.13 | $128.82 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $40.74 / $112.20
| Professional | 26 | $26.92 | $40.74 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $95.50 / $204.17
| Professional | TC | $61.66 | $95.50 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $147.91 / $234.42
| Professional | | $81.28 | $147.91 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $42.66 / $72.44
| Professional | 26 | $26.30 | $42.66 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $102.33 / $162.18
| Professional | TC | $56.23 | $102.33 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $144.54 / $162.18
| Professional | | $53.70 | $144.54 | $162.18 |
- 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
- $104.71 / $109.65 / $117.49
| Professional | TC | $104.71 | $109.65 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $138.04 / $162.18
| Professional | | $125.89 | $138.04 | $162.18 |
- 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
- $91.20 / $100.00 / $114.82
| Professional | TC | $91.20 | $100.00 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $147.91 / $724.44
| Professional | | $85.11 | $147.91 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $56.23 / $213.80
| Professional | 26 | $34.67 | $56.23 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $104.71 / $575.44
| Professional | TC | $75.86 | $104.71 | $575.44 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $165.96 / $251.19
| Professional | | $134.90 | $165.96 | $251.19 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $50.12 / $72.44
| Professional | 26 | $36.31 | $50.12 | $72.44 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $120.23 / $177.83
| Professional | TC | $87.10 | $120.23 | $177.83 |