- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $288.40 / $512.86
| Facility | | $97.72 | $288.40 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $67.61 / $89.13
| Facility | 26 | $44.67 | $67.61 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $114.82 / $426.58
| Professional | | $69.18 | $114.82 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $66.07 / $151.36
| Professional | 26 | $28.84 | $66.07 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $72.44 / $229.09 / $776.25
| Professional | 50 | $72.44 | $229.09 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $61.66 / $234.42
| Professional | TC | $41.69 | $61.66 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $239.88 / $302.00
| Facility | | $57.54 | $239.88 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $162.18 / $239.88
| Professional | | $89.13 | $162.18 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $58.88 / $91.20
| Professional | 26 | $33.88 | $58.88 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $100.00 / $151.36
| Professional | TC | $56.23 | $100.00 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $181.97 / $218.78
| Professional | | $162.18 | $181.97 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $66.07 / $77.62
| Professional | 26 | $58.88 | $66.07 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $112.20 / $141.25
| Professional | TC | $100.00 | $112.20 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $151.36 / $407.38
| Facility | | $81.28 | $151.36 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $64.57 / $87.10
| Facility | 26 | $44.67 | $64.57 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $169.82 / $269.15
| Professional | | $89.13 | $169.82 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $66.07 / $102.33
| Professional | 26 | $35.48 | $66.07 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $69.18 / $173.78 / $724.44
| Professional | 50 | $69.18 | $173.78 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $107.15 / $162.18
| Professional | TC | $58.88 | $107.15 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $102.33 / $165.96
| Facility | | $61.66 | $102.33 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $64.57 / $102.33
| Professional | | $48.98 | $64.57 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $120.23 / $218.78
| Facility | | $74.13 | $120.23 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $173.78 / $239.88
| Professional | | $134.90 | $173.78 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $66.07 / $93.33
| Professional | 26 | $42.66 | $66.07 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $107.15 / $151.36
| Professional | TC | $67.61 | $107.15 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $281.84 / $371.54
| Facility | | $204.17 | $281.84 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $208.93
| Facility | 26 | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $186.21 / $245.47
| Professional | | $154.88 | $186.21 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $70.79 / $93.33
| Professional | 26 | $60.26 | $70.79 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $117.49 / $151.36
| Professional | TC | $95.50 | $117.49 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $323.59 / $426.58
| Facility | | $263.03 | $323.59 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $102.33 / $229.09
| Professional | | $85.11 | $102.33 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $38.02 / $89.13
| Professional | 26 | $33.11 | $38.02 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $63.10 / $141.25
| Professional | TC | $52.48 | $63.10 | $141.25 |