- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $34.67 / $42.66
| Facility | 26 | $30.20 | $34.67 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $112.20 / $380.19
| Professional | | $64.57 | $112.20 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $36.31 / $61.66
| Professional | 26 | $28.84 | $36.31 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $72.44 / $120.23
| Professional | TC | $33.11 | $72.44 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $117.49 / $144.54
| Professional | | $61.66 | $117.49 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $42.66 / $56.23
| Professional | 26 | $36.31 | $42.66 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $79.43 / $97.72
| Professional | TC | $17.38 | $79.43 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $109.65 / $144.54
| Professional | | $77.62 | $109.65 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $44.67 / $45.71
| Professional | 26 | $42.66 | $44.67 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $93.33 / $97.72
| Professional | TC | $85.11 | $93.33 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $141.25 / $177.83
| Professional | | $128.82 | $141.25 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $42.66 / $52.48
| Professional | 26 | $38.90 | $42.66 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $91.20 / $97.72 / $123.03
| Professional | TC | $91.20 | $97.72 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $112.20 / $158.49
| Professional | | $70.79 | $112.20 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $41.69 / $56.23
| Professional | 26 | $32.36 | $41.69 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $77.62 / $102.33
| Professional | TC | $26.92 | $77.62 | $102.33 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $104.71 / $151.36
| Professional | | $52.48 | $104.71 | $151.36 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $38.90 / $44.67
| Professional | 26 | $25.70 | $38.90 | $44.67 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.49 / $72.44 / $107.15
| Professional | TC | $15.49 | $72.44 | $107.15 |