- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $302.00 / $812.83
| Facility | | $123.03 | $302.00 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $46.77 / $218.78
| Facility | 26 | $29.51 | $46.77 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $204.17 / $588.84
| Facility | TC | $100.00 | $204.17 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $141.25 / $331.13
| Professional | | $89.13 | $141.25 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $38.90 / $97.72
| Professional | 26 | $28.84 | $38.90 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $181.97
| Professional | 52 | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $85.11 / $199.53
| Professional | TC | $60.26 | $85.11 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $93.33 / $123.03
| Professional | | $72.44 | $93.33 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $30.90 / $64.57
| Professional | 26 | $26.92 | $30.90 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $363.08 / $2,630.27
| Facility | | $77.62 | $363.08 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $288.40 / $549.54 / $794.33
| Facility | TC | $288.40 | $549.54 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $141.25 / $346.74
| Professional | | $131.83 | $141.25 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $41.69 / $81.28
| Professional | 26 | $38.90 | $41.69 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $100.00 / $186.21
| Professional | TC | $97.72 | $100.00 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $204.17 / $354.81
| Facility | | $181.97 | $204.17 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $147.91 / $245.47
| Professional | | $91.20 | $147.91 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $45.71 / $74.13
| Professional | 26 | $28.18 | $45.71 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $102.33 / $177.83
| Professional | TC | $61.66 | $102.33 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $144.54 / $223.87
| Professional | | $109.65 | $144.54 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $45.71 / $72.44
| Professional | 26 | $34.67 | $45.71 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $97.72 / $151.36
| Professional | TC | $75.86 | $97.72 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $389.05 / $9,772.37
| Facility | | $162.18 | $389.05 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $109.65 / $8,709.64 / $25,118.86
| Facility | TC | $109.65 | $8,709.64 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $114.82 / $251.19
| Professional | | $97.72 | $114.82 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $35.48 / $70.79
| Professional | 26 | $30.20 | $35.48 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $79.43 / $186.21
| Professional | TC | $67.61 | $79.43 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $177.83 / $302.00
| Facility | | $120.23 | $177.83 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $128.82 / $223.87
| Professional | | $83.18 | $128.82 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $39.81 / $72.44
| Professional | 26 | $25.70 | $39.81 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $57.54 / $89.13 / $158.49
| Professional | TC | $57.54 | $89.13 | $158.49 |