- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $512.86 / $977.24
| Facility | | $147.91 | $512.86 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $30.90 / $38.90
| Facility | 26 | $21.88 | $30.90 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $181.97 / $436.52
| Professional | | $117.49 | $181.97 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $31.62 / $81.28
| Professional | 26 | $19.95 | $31.62 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $131.83 / $245.47
| Professional | TC | $97.72 | $131.83 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $104.71 / $199.53
| Professional | | $85.11 | $104.71 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $28.84 / $38.02
| Professional | 26 | $18.20 | $28.84 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $33.11
| Professional | 52 | $33.11 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $85.11
| Professional | TC | $79.43 | $79.43 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $446.68 / $1,621.81
| Facility | | $263.03 | $446.68 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $72.44 / $229.09
| Professional | | $24.55 | $72.44 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $338.84 / $954.99
| Facility | | $199.53 | $338.84 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $181.97 / $302.00
| Professional | | $123.03 | $181.97 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $30.20 / $46.77
| Professional | 26 | $20.89 | $30.20 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $107.15 / $154.88 / $257.04
| Professional | TC | $107.15 | $154.88 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $223.87 / $512.86
| Professional | | $134.90 | $223.87 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $38.02 / $158.49
| Professional | 26 | $24.55 | $38.02 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $112.20 / $162.18 / $416.87
| Professional | TC | $112.20 | $162.18 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | 26 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $154.88 / $169.82
| Professional | | $151.36 | $154.88 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $26.92 / $28.84
| Professional | 26 | $25.12 | $26.92 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $131.83 / $141.25
| Professional | TC | $125.89 | $131.83 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $190.55 / $575.44
| Facility | | $26.92 | $190.55 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $173.78 / $281.84
| Professional | | $125.89 | $173.78 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $38.02 / $58.88
| Professional | 26 | $22.39 | $38.02 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $104.71 / $147.91 / $245.47
| Professional | TC | $104.71 | $147.91 | $245.47 |