- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $109.65 / $128.82
| Facility | 26 | $97.72 | $109.65 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $1,023.29 / $1,445.44
| Professional | | $616.60 | $1,023.29 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $537.03 / $891.25 / $1,288.25
| Professional | TC | $537.03 | $891.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $588.84 / $1,819.70
| Professional | | $281.84 | $588.84 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $501.19 / $1,698.24
| Professional | TC | $162.18 | $501.19 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,698.24 / $1,778.28
| Professional | | $1,318.26 | $1,698.24 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,288.25 / $1,348.96 / $1,548.82
| Professional | TC | $1,288.25 | $1,348.96 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,380.38 / $1,621.81
| Professional | | $1,202.26 | $1,380.38 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $123.03 / $144.54
| Professional | 26 | $107.15 | $123.03 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,096.48 / $1,258.93 / $1,479.11
| Professional | TC | $1,096.48 | $1,258.93 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $676.08 / $1,479.11
| Professional | | $562.34 | $676.08 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $467.74 / $549.54 / $1,288.25
| Professional | TC | $467.74 | $549.54 | $1,288.25 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $1,258.93 / $1,862.09
| Professional | | $389.05 | $1,258.93 | $1,862.09 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $1,122.02 / $1,698.24
| Professional | TC | $234.42 | $1,122.02 | $1,698.24 |