- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $776.25 / $2,238.72
| Facility | | $234.42 | $776.25 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $45.71 / $64.57
| Facility | 26 | $37.15 | $45.71 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $257.04 / $660.69
| Facility | TC | $194.98 | $257.04 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $288.40 / $602.56
| Professional | | $199.53 | $288.40 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $48.98 / $100.00
| Professional | 26 | $33.88 | $48.98 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $229.09 / $446.68
| Professional | TC | $169.82 | $229.09 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $177.83 / $323.59
| Professional | | $151.36 | $177.83 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $28.84 / $56.23
| Professional | 26 | $26.92 | $28.84 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $144.54 / $144.54 / $144.54
| Professional | TC | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $1,479.11 / $1,479.11
| Facility | | $1,479.11 | $1,479.11 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $257.04 / $407.38
| Professional | | $199.53 | $257.04 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $42.66 / $67.61
| Professional | 26 | $34.67 | $42.66 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $208.93 / $331.13
| Professional | TC | $162.18 | $208.93 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $269.15 / $354.81
| Professional | | $229.09 | $269.15 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $44.67 / $56.23
| Professional | 26 | $38.02 | $44.67 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $223.87 / $295.12
| Professional | TC | $199.53 | $223.87 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $741.31 / $1,000.00
| Facility | | $457.09 | $741.31 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $42.66 / $60.26
| Facility | 26 | $9.12 | $42.66 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $218.78 / $309.03
| Facility | TC | $46.77 | $218.78 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $338.84 / $660.69
| Professional | | $213.80 | $338.84 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $47.86 / $97.72
| Professional | 26 | $33.11 | $47.86 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $309.03 / $575.44
| Professional | TC | $194.98 | $309.03 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $331.13 / $691.83
| Facility | | $218.78 | $331.13 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $204.17 / $204.17
| Facility | 26 | $87.10 | $204.17 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $398.11 / $912.01 / $912.01
| Facility | TC | $398.11 | $912.01 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $363.08 / $1,949.84
| Professional | | $234.42 | $363.08 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $53.70 / $398.11
| Professional | 26 | $33.88 | $53.70 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $316.23 / $1,778.28
| Professional | TC | $199.53 | $316.23 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $263.03 / $794.33
| Facility | | $52.48 | $263.03 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $309.03 / $524.81
| Professional | | $234.42 | $309.03 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $44.67 / $85.11
| Professional | 26 | $30.20 | $44.67 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $263.03 / $407.38
| Professional | TC | $199.53 | $263.03 | $407.38 |