- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $416.87 / $630.96
| Facility | | $104.71 | $416.87 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $151.36 / $162.18
| Facility | 26 | $30.20 | $151.36 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $165.96 / $602.56
| Professional | | $102.33 | $165.96 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $38.02 / $123.03
| Professional | 26 | $22.91 | $38.02 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $239.88
| Professional | 52 | $83.18 | $83.18 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $97.72 / $288.40
| Professional | TC | $74.13 | $97.72 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $190.55 / $436.52
| Facility | | $112.20 | $190.55 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $151.36 / $234.42
| Professional | | $100.00 | $151.36 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $37.15 / $57.54
| Professional | 26 | $28.18 | $37.15 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $112.20 / $177.83
| Professional | TC | $75.86 | $112.20 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $190.55
| Professional | | $32.36 | $33.11 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $218.78 / $501.19
| Facility | | $151.36 | $218.78 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $199.53
| Facility | 26 | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $204.17 / $239.88
| Professional | | $154.88 | $204.17 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $50.12 / $60.26
| Professional | 26 | $37.15 | $50.12 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $117.49 / $151.36 / $181.97
| Professional | TC | $117.49 | $151.36 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $165.96 / $245.47
| Professional | | $102.33 | $165.96 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $42.66 / $63.10
| Professional | 26 | $25.70 | $42.66 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $125.89 / $181.97
| Professional | TC | $77.62 | $125.89 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $112.20 / $190.55
| Professional | | $36.31 | $112.20 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $117.49 / $194.98
| Professional | | $100.00 | $117.49 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $28.84 / $47.86
| Professional | 26 | $26.30 | $28.84 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $89.13 / $147.91
| Professional | TC | $81.28 | $89.13 | $147.91 |