- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $44.67 / $54.95
| Facility | 26 | $38.90 | $44.67 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $147.91 / $269.15
| Professional | | $114.82 | $147.91 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $46.77 / $81.28
| Professional | 26 | $39.81 | $46.77 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $104.71 / $151.36
| Professional | TC | $75.86 | $104.71 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $158.49 / $281.84
| Professional | | $128.82 | $158.49 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $54.95 / $79.43
| Professional | 26 | $46.77 | $54.95 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $102.33 / $199.53
| Professional | TC | $77.62 | $102.33 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $177.83 / $213.80
| Professional | | $74.13 | $177.83 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $63.10 / $64.57
| Professional | 26 | $60.26 | $63.10 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $141.25 / $147.91
| Professional | TC | $125.89 | $141.25 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $162.18 / $199.53
| Professional | | $147.91 | $162.18 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $53.70 / $67.61
| Professional | 26 | $48.98 | $53.70 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $107.15 / $134.90
| Professional | TC | $97.72 | $107.15 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $147.91 / $218.78
| Professional | | $117.49 | $147.91 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $53.70 / $72.44
| Professional | 26 | $42.66 | $53.70 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $91.20 / $144.54
| Professional | TC | $75.86 | $91.20 | $144.54 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $162.18 / $199.53
| Professional | | $100.00 | $162.18 | $199.53 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $53.70 / $58.88
| Professional | 26 | $33.11 | $53.70 | $58.88 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $109.65 / $147.91
| Professional | TC | $67.61 | $109.65 | $147.91 |