- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $204.17 / $338.84
| Facility | | $107.15 | $204.17 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $128.82 / $223.87
| Facility | 26 | $40.74 | $128.82 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $97.72 / $288.40
| Professional | | $45.71 | $97.72 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $60.26 / $125.89
| Professional | 26 | $28.18 | $60.26 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $66.07 / $169.82 / $630.96
| Professional | 50 | $66.07 | $169.82 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $58.88 / $147.91
| Professional | TC | $42.66 | $58.88 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $154.88 / $218.78
| Facility | | $107.15 | $154.88 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $120.23 / $186.21
| Professional | | $85.11 | $120.23 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $45.71 / $69.18
| Professional | 26 | $31.62 | $45.71 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $125.89 / $181.97 / $269.15
| Professional | 50 | $125.89 | $181.97 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $74.13 / $109.65
| Professional | TC | $53.70 | $74.13 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $177.83 / $309.03
| Facility | | $89.13 | $177.83 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $128.82 / $223.87
| Professional | | $93.33 | $128.82 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $46.77 / $83.18
| Professional | 26 | $35.48 | $46.77 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $81.28 / $141.25
| Professional | TC | $58.88 | $81.28 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $114.82 / $144.54
| Professional | | $93.33 | $114.82 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $42.66 / $51.29
| Professional | 26 | $36.31 | $42.66 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $74.13 / $89.13
| Professional | TC | $61.66 | $74.13 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $269.15 / $630.96
| Facility | | $165.96 | $269.15 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $69.18 / $204.17
| Professional | | $46.77 | $69.18 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $109.65 / $190.55
| Professional | | $74.13 | $109.65 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $40.74 / $89.13
| Professional | 26 | $27.54 | $40.74 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $125.89
| Professional | 50 | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $69.18 / $131.83
| Professional | TC | $46.77 | $69.18 | $131.83 |