- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $831.76 / $1,548.82
| Facility | | $223.87 | $831.76 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $33.88 / $446.68
| Facility | 26 | $27.54 | $33.88 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $588.84 / $1,122.02
| Facility | TC | $123.03 | $588.84 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $269.15 / $741.31
| Professional | | $165.96 | $269.15 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $45.71 / $125.89
| Professional | 26 | $30.20 | $45.71 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $134.90 / $177.83 / $354.81
| Professional | TC | $134.90 | $177.83 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $151.36 / $245.47
| Professional | | $128.82 | $151.36 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $31.62 / $57.54
| Professional | 26 | $23.99 | $31.62 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $112.20 / $117.49 / $218.78
| Professional | TC | $112.20 | $117.49 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $169.82 / $331.13
| Facility | | $102.33 | $169.82 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $154.88 / $177.83
| Professional | | $123.03 | $154.88 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $512.86 / $758.58
| Facility | | $218.78 | $512.86 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $41.69 / $104.71
| Facility | 26 | $7.94 | $41.69 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $165.96 / $234.42
| Facility | TC | $35.48 | $165.96 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $257.04 / $478.63
| Professional | | $154.88 | $257.04 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $44.67 / $85.11
| Professional | 26 | $30.90 | $44.67 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $229.09 / $416.87
| Professional | TC | $141.25 | $229.09 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $446.68 / $977.24
| Facility | | $204.17 | $446.68 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $37.15
| Facility | 26 | $37.15 | $37.15 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $169.82
| Facility | TC | $169.82 | $169.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $199.53 / $288.40
| Professional | | $100.00 | $199.53 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $32.36 / $50.12
| Professional | 26 | $15.14 | $32.36 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $165.96 / $229.09
| Professional | TC | $85.11 | $165.96 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $109.65 / $213.80
| Professional | | $29.51 | $109.65 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $134.90 / $288.40
| Facility | | $25.70 | $134.90 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $234.42 / $416.87
| Professional | | $151.36 | $234.42 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $39.81 / $79.43
| Professional | 26 | $27.54 | $39.81 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $190.55 / $338.84
| Professional | TC | $125.89 | $190.55 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $190.55
| Professional | | $141.25 | $141.25 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $34.67
| Professional | 26 | $24.55 | $24.55 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $154.88
| Professional | TC | $117.49 | $117.49 | $154.88 |