- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $436.52 / $489.78 / $575.44
| Facility | 26 | $436.52 | $489.78 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $2,089.30 / $5,495.41
| Professional | | $1,479.11 | $2,089.30 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $302.00 / $512.86 / $1,047.13
| Professional | 26 | $302.00 | $512.86 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,122.02 / $1,949.84 / $3,019.95
| Professional | TC | $1,122.02 | $1,949.84 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $1,905.46 / $4,265.80
| Professional | | $1,548.82 | $1,905.46 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $323.59 / $446.68 / $870.96
| Professional | 26 | $323.59 | $446.68 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,122.02 / $1,513.56 / $3,388.44
| Professional | TC | $1,122.02 | $1,513.56 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $2,630.27 / $2,691.53
| Professional | | $2,344.23 | $2,630.27 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $537.03 / $549.54 / $575.44
| Professional | 26 | $537.03 | $549.54 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,949.84 / $2,089.30 / $2,137.96
| Professional | TC | $1,949.84 | $2,089.30 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $2,630.27 / $3,019.95
| Professional | | $2,187.76 | $2,630.27 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $446.68 / $524.81 / $602.56
| Professional | 26 | $446.68 | $524.81 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,778.28 / $2,089.30 / $2,454.71
| Professional | TC | $1,778.28 | $2,089.30 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,630.27 / $14,454.40
| Professional | | $1,584.89 | $2,630.27 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $489.78 / $3,311.31
| Professional | 26 | $87.10 | $489.78 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $2,089.30 / $11,220.18
| Professional | TC | $85.11 | $2,089.30 | $11,220.18 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $3,162.28 / $5,248.07
| Professional | | $1,905.46 | $3,162.28 | $5,248.07 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $436.52 / $630.96 / $1,000.00
| Professional | 26 | $436.52 | $630.96 | $1,000.00 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,479.11 / $2,344.23 / $4,265.80
| Professional | TC | $1,479.11 | $2,344.23 | $4,265.80 |