- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $512.86 / $933.25
| Facility | | $275.42 | $512.86 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $25.12 / $25.12
| Facility | 26 | $25.12 | $25.12 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $141.25 / $302.00
| Professional | | $40.74 | $141.25 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $33.11 / $64.57
| Professional | 26 | $20.89 | $33.11 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $117.49 / $245.47
| Professional | TC | $100.00 | $117.49 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $169.82 / $331.13
| Professional | | $123.03 | $169.82 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $28.18 / $47.86
| Professional | 26 | $20.89 | $28.18 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $104.71 / $141.25 / $281.84
| Professional | TC | $104.71 | $141.25 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $223.87 / $346.74
| Professional | | $158.49 | $223.87 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $29.51 / $53.70
| Professional | 26 | $19.95 | $29.51 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $117.49 / $190.55 / $295.12
| Professional | TC | $117.49 | $190.55 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $218.78 / $398.11
| Professional | | $165.96 | $218.78 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $35.48 / $64.57
| Professional | 26 | $26.30 | $35.48 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $138.04 / $190.55 / $338.84
| Professional | TC | $138.04 | $190.55 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $173.78
| Facility | | $141.25 | $141.25 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $25.12 / $28.18
| Facility | 26 | $25.12 | $25.12 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $169.82 / $331.13
| Professional | | $123.03 | $169.82 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $28.84 / $53.70
| Professional | 26 | $20.89 | $28.84 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $102.33 / $131.83 / $257.04
| Professional | TC | $102.33 | $131.83 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $223.87 / $436.52
| Professional | | $144.54 | $223.87 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $35.48 / $75.86
| Professional | 26 | $22.91 | $35.48 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $177.83 / $323.59
| Professional | TC | $123.03 | $177.83 | $323.59 |