- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $851.14 / $3,162.28
| Facility | | $288.40 | $851.14 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $165.96 / $239.88
| Facility | 26 | $69.18 | $165.96 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $331.13 / $933.25
| Professional | | $181.97 | $331.13 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $77.62 / $269.15
| Professional | 26 | $63.10 | $77.62 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $117.49 / $181.97 / $537.03
| Professional | TC | $117.49 | $181.97 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $162.18 / $190.55
| Professional | | $144.54 | $162.18 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $56.23 / $85.11
| Professional | 26 | $52.48 | $56.23 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $933.25 / $1,819.70
| Facility | | $275.42 | $933.25 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $218.78 / $389.05
| Professional | | $194.98 | $218.78 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $75.86 / $134.90
| Professional | 26 | $67.61 | $75.86 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $141.25 / $251.19
| Professional | TC | $125.89 | $141.25 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $281.84 / $457.09
| Professional | | $194.98 | $281.84 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $87.10 / $158.49
| Professional | 26 | $66.07 | $87.10 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $131.83 / $199.53 / $302.00
| Professional | TC | $131.83 | $199.53 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $251.19 / $912.01
| Facility | | $181.97 | $251.19 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $162.18 / $309.03 / $309.03
| Facility | 26 | $162.18 | $309.03 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $288.40 / $3,981.07
| Professional | | $194.98 | $288.40 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $87.10 / $436.52
| Professional | 26 | $61.66 | $87.10 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $128.82 / $199.53 / $1,000.00
| Professional | TC | $128.82 | $199.53 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $181.97 / $302.00
| Facility | | $58.88 | $181.97 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $251.19 / $416.87
| Professional | | $181.97 | $251.19 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $79.43 / $128.82
| Professional | 26 | $60.26 | $79.43 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $169.82 / $275.42
| Professional | TC | $123.03 | $169.82 | $275.42 |