- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $48.98 / $57.54
| Facility | 26 | $42.66 | $48.98 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $104.71 / $309.03
| Professional | | $53.70 | $104.71 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $40.74 / $117.49
| Professional | 26 | $24.55 | $40.74 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.96 / $33.11 / $97.72
| Professional | TC | $10.96 | $33.11 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $107.15 / $208.93
| Professional | | $53.70 | $107.15 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $44.67 / $91.20
| Professional | 26 | $27.54 | $44.67 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.72 / $30.90 / $147.91
| Professional | TC | $10.72 | $30.90 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $141.25 / $162.18
| Professional | | $91.20 | $141.25 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $54.95 / $57.54
| Professional | 26 | $53.70 | $54.95 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $102.33 / $107.15 / $112.20
| Professional | TC | $102.33 | $107.15 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $67.61 / $79.43
| Professional | | $61.66 | $67.61 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $52.48 / $61.66
| Professional | 26 | $47.86 | $52.48 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.49 / $14.79 / $17.38
| Professional | TC | $13.49 | $14.79 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $100.00 / $173.78
| Professional | | $61.66 | $100.00 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $48.98 / $245.47
| Professional | 26 | $32.36 | $48.98 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.75 / $72.44 / $125.89
| Professional | TC | $11.75 | $72.44 | $125.89 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $128.82 / $257.04
| Professional | | $67.61 | $128.82 | $257.04 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $52.48 / $66.07
| Professional | 26 | $31.62 | $52.48 | $66.07 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $107.15 / $194.98
| Professional | TC | $17.38 | $107.15 | $194.98 |