- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $13.18 / $15.85
| Facility | 26 | $11.75 | $13.18 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $104.71 / $371.54
| Professional | | $75.86 | $104.71 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $12.88 / $83.18
| Professional | 26 | $10.00 | $12.88 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $91.20 / $239.88
| Professional | TC | $63.10 | $91.20 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $147.91 / $213.80
| Professional | | $100.00 | $147.91 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $13.80 / $22.39
| Professional | 26 | $9.77 | $13.80 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $131.83 / $194.98
| Professional | TC | $87.10 | $131.83 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $194.98 / $213.80
| Professional | | $134.90 | $194.98 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $15.49 / $16.22
| Professional | 26 | $15.14 | $15.49 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $158.49
| Professional | TC | $151.36 | $151.36 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $131.83 / $165.96
| Professional | | $114.82 | $131.83 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $13.80 / $17.38
| Professional | 26 | $12.02 | $13.80 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $102.33 / $120.23 / $147.91
| Professional | TC | $102.33 | $120.23 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $208.93 / $346.74
| Professional | | $112.20 | $208.93 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $15.85 / $28.84
| Professional | 26 | $11.22 | $15.85 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $102.33 / $194.98 / $316.23
| Professional | TC | $102.33 | $194.98 | $316.23 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $162.18 / $204.17
| Professional | | $134.90 | $162.18 | $204.17 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $17.38 / $29.51
| Professional | 26 | $13.18 | $17.38 | $29.51 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $117.49 / $141.25 / $173.78
| Professional | TC | $117.49 | $141.25 | $173.78 |