- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $158.49 / $177.83 / $208.93
| Facility | 26 | $158.49 | $177.83 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $457.09 / $676.08
| Professional | | $275.42 | $457.09 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $154.88 / $229.09
| Professional | 26 | $100.00 | $154.88 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $269.15 / $446.68
| Professional | TC | $162.18 | $269.15 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $389.05 / $758.58
| Professional | | $281.84 | $389.05 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $169.82 / $316.23
| Professional | 26 | $117.49 | $169.82 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $218.78 / $467.74
| Professional | TC | $162.18 | $218.78 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $588.84 / $660.69
| Professional | | $478.63 | $588.84 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $194.98 / $204.17 / $239.88
| Professional | 26 | $194.98 | $204.17 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $426.58 / $446.68 / $562.34
| Professional | TC | $426.58 | $446.68 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $616.60 / $707.95
| Professional | | $512.86 | $616.60 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $162.18 / $190.55 / $218.78
| Professional | 26 | $162.18 | $190.55 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $363.08 / $426.58 / $489.78
| Professional | TC | $363.08 | $426.58 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $489.78 / $691.83
| Professional | | $263.03 | $489.78 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $208.93 / $1,202.26
| Professional | 26 | $87.10 | $208.93 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $281.84 / $467.74
| Professional | TC | $151.36 | $281.84 | $467.74 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $741.31 / $977.24
| Professional | | $602.56 | $741.31 | $977.24 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $190.55 / $229.09 / $389.05
| Professional | 26 | $190.55 | $229.09 | $389.05 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $389.05 / $512.86 / $588.84
| Professional | TC | $389.05 | $512.86 | $588.84 |