- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $354.81 / $891.25
| Facility | | $194.98 | $354.81 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $33.88 / $36.31
| Facility | 26 | $31.62 | $33.88 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $120.23 / $269.15
| Professional | | $72.44 | $120.23 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $30.20 / $66.07
| Professional | 26 | $20.89 | $30.20 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $89.13 / $194.98
| Professional | TC | $48.98 | $89.13 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $239.88 / $269.15
| Facility | | $194.98 | $239.88 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $147.91 / $186.21
| Professional | | $100.00 | $147.91 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $37.15 / $45.71
| Professional | 26 | $24.55 | $37.15 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $112.20 / $144.54
| Professional | TC | $77.62 | $112.20 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $154.88 / $257.04
| Professional | | $87.10 | $154.88 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $36.31 / $58.88
| Professional | 26 | $30.90 | $36.31 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $117.49 / $199.53
| Professional | TC | $61.66 | $117.49 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $177.83 / $245.47
| Professional | | $131.83 | $177.83 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $39.81 / $54.95
| Professional | 26 | $29.51 | $39.81 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $102.33 / $138.04 / $190.55
| Professional | TC | $102.33 | $138.04 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $147.91 / $17,378.01
| Facility | | $123.03 | $147.91 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $33.88 / $3,801.89
| Facility | 26 | $31.62 | $33.88 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $123.03 / $257.04
| Professional | | $75.86 | $123.03 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $31.62 / $64.57
| Professional | 26 | $23.99 | $31.62 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $93.33 / $194.98
| Professional | TC | $48.98 | $93.33 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $151.36 / $269.15
| Professional | | $102.33 | $151.36 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $38.90 / $58.88
| Professional | 26 | $28.18 | $38.90 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $117.49 / $208.93
| Professional | TC | $74.13 | $117.49 | $208.93 |