- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $660.69 / $851.14
| Facility | | $204.17 | $660.69 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $51.29 / $57.54
| Facility | 26 | $28.84 | $51.29 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $151.36 / $588.84
| Professional | | $52.48 | $151.36 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $28.84 / $100.00
| Professional | 26 | $18.62 | $28.84 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $120.23 / $239.88
| Professional | TC | $95.50 | $120.23 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $302.00 / $371.54
| Facility | | $131.83 | $302.00 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $275.42 / $446.68
| Professional | | $165.96 | $275.42 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $40.74 / $63.10
| Professional | 26 | $22.39 | $40.74 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $144.54 / $239.88 / $389.05
| Professional | TC | $144.54 | $239.88 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $302.00 / $371.54
| Professional | | $269.15 | $302.00 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $46.77 / $54.95
| Professional | 26 | $41.69 | $46.77 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $257.04 / $316.23
| Professional | TC | $229.09 | $257.04 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $213.80 / $537.03
| Facility | | $128.82 | $213.80 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $51.29 / $57.54
| Facility | 26 | $28.84 | $51.29 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $281.84 / $389.05
| Professional | | $151.36 | $281.84 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $45.71 / $66.07
| Professional | 26 | $23.44 | $45.71 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $239.88 / $354.81
| Professional | TC | $123.03 | $239.88 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $234.42 / $288.40
| Facility | | $38.90 | $234.42 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $87.10 / $281.84
| Professional | | $30.90 | $87.10 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $204.17 / $389.05
| Facility | | $128.82 | $204.17 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $309.03 / $416.87
| Professional | | $239.88 | $309.03 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $45.71 / $63.10
| Professional | 26 | $29.51 | $45.71 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $181.97 / $263.03 / $354.81
| Professional | TC | $181.97 | $263.03 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $389.05 / $467.74
| Facility | | $288.40 | $389.05 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $389.05
| Facility | 26 | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $338.84 / $416.87
| Professional | | $263.03 | $338.84 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $51.29 / $66.07
| Professional | 26 | $42.66 | $51.29 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $281.84 / $346.74
| Professional | TC | $223.87 | $281.84 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $389.05 / $512.86
| Facility | | $316.23 | $389.05 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $275.42 / $407.38
| Professional | | $151.36 | $275.42 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $41.69 / $67.61
| Professional | 26 | $22.39 | $41.69 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $128.82 / $229.09 / $354.81
| Professional | TC | $128.82 | $229.09 | $354.81 |