- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $457.09 / $741.31
| Facility | | $151.36 | $457.09 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $269.15 / $269.15 / $338.84
| Facility | TC | $269.15 | $269.15 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $89.13 / $213.80
| Professional | | $63.10 | $89.13 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $70.79 / $218.78
| Professional | 26 | $26.92 | $70.79 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $64.57 / $162.18
| Professional | TC | $39.81 | $64.57 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $123.03
| Facility | | $123.03 | $123.03 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $100.00 / $181.97
| Professional | | $51.29 | $100.00 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $28.84 / $64.57
| Professional | 26 | $16.98 | $28.84 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $70.79 / $125.89
| Professional | TC | $31.62 | $70.79 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $218.78 / $316.23
| Professional | | $109.65 | $218.78 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $66.07 / $93.33
| Professional | 26 | $32.36 | $66.07 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $154.88 / $218.78
| Professional | TC | $77.62 | $154.88 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $186.21 / $512.86
| Facility | | $107.15 | $186.21 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $269.15 / $269.15 / $338.84
| Facility | TC | $269.15 | $269.15 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $181.97 / $331.13
| Professional | | $77.62 | $181.97 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $72.44 / $112.20
| Professional | 26 | $33.11 | $72.44 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $57.54 / $117.49 / $177.83
| Professional | TC | $57.54 | $117.49 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $131.83 / $213.80
| Facility | | $58.88 | $131.83 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $151.36
| Professional | | $75.86 | $75.86 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $147.91 / $269.15
| Facility | | $89.13 | $147.91 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $186.21 / $316.23
| Professional | | $100.00 | $186.21 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $35.48 / $97.72
| Professional | 26 | $18.62 | $35.48 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $75.86 / $229.09
| Professional | TC | $34.67 | $75.86 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $645.65 / $676.08
| Facility | | $645.65 | $645.65 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $213.80 / $338.84
| Professional | | $141.25 | $213.80 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $70.79 / $107.15
| Professional | 26 | $47.86 | $70.79 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $141.25 / $229.09
| Professional | TC | $93.33 | $141.25 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $89.13 / $316.23
| Professional | | $63.10 | $89.13 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $41.69 / $107.15
| Professional | 26 | $21.88 | $41.69 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $70.79 / $208.93
| Professional | TC | $42.66 | $70.79 | $208.93 |