- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $85.11 / $100.00
| Facility | 26 | $75.86 | $85.11 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $338.84 / $891.25
| Professional | | $194.98 | $338.84 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $89.13 / $141.25
| Professional | 26 | $64.57 | $89.13 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $194.98 / $354.81
| Professional | TC | $125.89 | $194.98 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $281.84 / $436.52
| Professional | | $204.17 | $281.84 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $91.20 / $144.54
| Professional | 26 | $63.10 | $91.20 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $190.55 / $295.12
| Professional | TC | $141.25 | $190.55 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $724.44 / $812.83
| Professional | | $501.19 | $724.44 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $100.00 / $104.71
| Professional | 26 | $97.72 | $100.00 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $562.34 / $562.34 / $588.84
| Professional | TC | $562.34 | $562.34 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $281.84 / $331.13
| Professional | | $245.47 | $281.84 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $89.13 / $104.71
| Professional | 26 | $77.62 | $89.13 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $194.98 / $229.09
| Professional | TC | $165.96 | $194.98 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $537.03 / $1,348.96
| Professional | | $85.11 | $537.03 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $102.33 / $616.60
| Professional | 26 | $87.10 | $102.33 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $478.63 / $1,174.90
| Professional | TC | $173.78 | $478.63 | $1,174.90 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $398.11 / $575.44
| Professional | | $302.00 | $398.11 | $575.44 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $109.65 / $134.90
| Professional | 26 | $91.20 | $109.65 | $134.90 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $239.88 / $316.23
| Professional | TC | $204.17 | $239.88 | $316.23 |