- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $691.83 / $1,479.11
| Facility | | $186.21 | $691.83 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $34.67
| Facility | 26 | $28.18 | $28.18 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $91.20 / $213.80 / $575.44
| Facility | TC | $91.20 | $213.80 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $112.20 / $446.68
| Professional | | $74.13 | $112.20 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $35.48 / $131.83
| Professional | 26 | $22.91 | $35.48 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $50.12 / $79.43 / $154.88
| Professional | TC | $50.12 | $79.43 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $70.79 / $199.53
| Professional | | $58.88 | $70.79 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $41.69 / $79.43
| Professional | 26 | $21.88 | $41.69 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $46.77
| Professional | TC | $46.77 | $46.77 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $112.20 / $112.20
| Facility | | $70.79 | $112.20 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $97.72 / $144.54
| Professional | | $83.18 | $97.72 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $30.90 / $46.77
| Professional | 26 | $26.92 | $30.90 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $57.54 / $66.07 / $100.00
| Professional | TC | $57.54 | $66.07 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $204.17 / $676.08
| Facility | | $134.90 | $204.17 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $114.82 / $169.82
| Professional | | $83.18 | $114.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $37.15 / $54.95
| Professional | 26 | $23.44 | $37.15 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $79.43 / $117.49
| Professional | TC | $56.23 | $79.43 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.69 / $102.33 / $151.36
| Professional | | $0.69 | $102.33 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.32 / $31.62 / $45.71
| Professional | 26 | $0.32 | $31.62 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $0.38 / $70.79 / $104.71
| Professional | TC | $0.38 | $70.79 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.69 / $0.69 / $128.82
| Professional | | $0.69 | $0.69 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.32 / $0.32 / $40.74
| Professional | 26 | $0.32 | $0.32 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $0.38 / $89.13 / $89.13
| Professional | TC | $0.38 | $89.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $85.11 / $120.23
| Professional | | $81.28 | $85.11 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $27.54 / $39.81
| Professional | 26 | $26.92 | $27.54 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $57.54 / $58.88 / $81.28
| Professional | TC | $57.54 | $58.88 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $61.66 / $245.47
| Facility | | $54.95 | $61.66 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $93.33 / $151.36
| Professional | | $74.13 | $93.33 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $30.20 / $48.98
| Professional | 26 | $21.38 | $30.20 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $51.29 / $63.10 / $107.15
| Professional | TC | $51.29 | $63.10 | $107.15 |