- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $398.11 / $776.25
| Facility | | $102.33 | $398.11 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $57.54
| Facility | 26 | $45.71 | $45.71 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $213.80 / $676.08
| Professional | | $102.33 | $213.80 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $56.23 / $177.83
| Professional | 26 | $35.48 | $56.23 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $102.33 / $245.47
| Professional | TC | $67.61 | $102.33 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $95.50 / $117.49
| Professional | | $81.28 | $95.50 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $38.02 / $67.61
| Professional | 26 | $30.20 | $38.02 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $61.66 / $69.18
| Professional | TC | $43.65 | $61.66 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $190.55 / $331.13
| Facility | | $128.82 | $190.55 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $173.78 / $186.21
| Professional | | $154.88 | $173.78 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $60.26
| Professional | 26 | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $123.03
| Professional | TC | $123.03 | $123.03 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $93.33 / $165.96
| Facility | | $47.86 | $93.33 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $89.13 / $154.88
| Professional | | $38.90 | $89.13 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $223.87 / $223.87
| Facility | | $223.87 | $223.87 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $154.88 / $316.23
| Professional | | $93.33 | $154.88 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $46.77 / $97.72
| Professional | 26 | $30.90 | $46.77 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $97.72 / $229.09
| Professional | TC | $63.10 | $97.72 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $407.38 / $794.33
| Facility | | $128.82 | $407.38 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $83.18
| Facility | 26 | $45.71 | $45.71 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $158.49 / $398.11
| Professional | | $107.15 | $158.49 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $50.12 / $144.54
| Professional | 26 | $34.67 | $50.12 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $100.00 / $194.98
| Professional | TC | $70.79 | $100.00 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $223.87 / $223.87
| Facility | | $223.87 | $223.87 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $138.04 / $223.87
| Professional | | $91.20 | $138.04 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $43.65 / $79.43
| Professional | 26 | $30.20 | $43.65 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $85.11 / $186.21
| Professional | TC | $61.66 | $85.11 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $107.15 / $275.42
| Facility | | $66.07 | $107.15 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $141.25 / $331.13
| Professional | | $95.50 | $141.25 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $47.86 / $239.88
| Professional | 26 | $38.02 | $47.86 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $95.50 / $229.09
| Professional | TC | $77.62 | $95.50 | $229.09 |