- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $562.34 / $1,949.84
| Facility | | $100.00 | $562.34 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $102.33 / $630.96
| Facility | 26 | $97.72 | $102.33 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $245.47 / $933.25
| Professional | | $154.88 | $245.47 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $74.13 / $269.15
| Professional | 26 | $53.70 | $74.13 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $154.88 / $245.47
| Professional | TC | $100.00 | $154.88 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $2,398.83 / $3,890.45
| Facility | | $676.08 | $2,398.83 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $134.90 / $223.87
| Professional | | $48.98 | $134.90 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $302.00 / $380.19
| Professional | | $218.78 | $302.00 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $93.33 / $120.23
| Professional | 26 | $72.44 | $93.33 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $208.93 / $263.03
| Professional | TC | $141.25 | $208.93 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $269.15
| Professional | | $32.36 | $33.11 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $275.42 / $457.09
| Facility | | $190.55 | $275.42 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $331.13 / $457.09
| Professional | | $223.87 | $331.13 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $95.50 / $120.23
| Professional | 26 | $67.61 | $95.50 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $138.04 / $208.93 / $263.03
| Professional | TC | $138.04 | $208.93 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $331.13 / $2,398.83
| Facility | | $95.50 | $331.13 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $346.74 / $478.63
| Professional | | $213.80 | $346.74 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $102.33 / $144.54
| Professional | 26 | $75.86 | $102.33 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $134.90 / $245.47 / $338.84
| Professional | TC | $134.90 | $245.47 | $338.84 |