- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $316.23 / $851.14
| Facility | | $89.13 | $316.23 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $34.67 / $64.57
| Facility | 26 | $26.92 | $34.67 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $123.03 / $741.31
| Facility | TC | $56.23 | $123.03 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $112.20 / $426.58
| Professional | | $70.79 | $112.20 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $41.69 / $112.20
| Professional | 26 | $23.99 | $41.69 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $79.43 / $186.21
| Professional | TC | $48.98 | $79.43 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $64.57 / $141.25
| Professional | | $57.54 | $64.57 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $26.30 / $45.71
| Professional | 26 | $20.89 | $26.30 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.02 / $42.66 / $100.00
| Professional | TC | $38.02 | $42.66 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $104.71 / $169.82
| Professional | | $83.18 | $104.71 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $35.48 / $57.54
| Professional | 26 | $28.84 | $35.48 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $67.61 / $112.20
| Professional | TC | $53.70 | $67.61 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $81.28 / $144.54
| Facility | | $61.66 | $81.28 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $93.33 / $141.25
| Professional | | $89.13 | $93.33 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $32.36 / $46.77
| Professional | 26 | $29.51 | $32.36 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $63.10 / $95.50
| Professional | TC | $58.88 | $63.10 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $204.17 / $457.09
| Facility | | $138.04 | $204.17 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $31.62 / $45.71
| Facility | 26 | $6.76 | $31.62 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.80 / $64.57 / $91.20
| Facility | TC | $13.80 | $64.57 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $109.65 / $218.78
| Professional | | $72.44 | $109.65 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $35.48 / $72.44
| Professional | 26 | $23.99 | $35.48 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $50.12 / $75.86 / $147.91
| Professional | TC | $50.12 | $75.86 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $125.89 / $512.86
| Facility | | $81.28 | $125.89 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $125.89 / $125.89
| Facility | 26 | $66.07 | $125.89 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $269.15 / $269.15
| Facility | TC | $125.89 | $269.15 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $114.82 / $562.34
| Professional | | $83.18 | $114.82 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $39.81 / $229.09
| Professional | 26 | $28.18 | $39.81 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $79.43 / $389.05
| Professional | TC | $54.95 | $79.43 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $114.82 / $213.80
| Facility | | $83.18 | $114.82 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $102.33 / $190.55
| Professional | | $83.18 | $102.33 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $33.11 / $85.11
| Professional | 26 | $26.92 | $33.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $69.18 / $125.89
| Professional | TC | $56.23 | $69.18 | $125.89 |