- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $776.25 / $1,258.93
| Facility | | $239.88 | $776.25 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $66.07 / $141.25
| Facility | 26 | $30.20 | $66.07 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $630.96 / $1,000.00
| Facility | TC | $208.93 | $630.96 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $295.12 / $954.99
| Professional | | $169.82 | $295.12 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $43.65 / $154.88
| Professional | 26 | $30.20 | $43.65 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $194.98 / $446.68
| Professional | TC | $141.25 | $194.98 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $398.11 / $660.69
| Professional | | $204.17 | $398.11 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $67.61 / $95.50
| Professional | 26 | $33.88 | $67.61 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $331.13 / $575.44
| Professional | TC | $165.96 | $331.13 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $380.19 / $645.65
| Professional | | $181.97 | $380.19 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $60.26 / $173.78
| Professional | 26 | $32.36 | $60.26 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $257.04 / $489.78
| Professional | TC | $147.91 | $257.04 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $426.58 / $831.76
| Facility | | $239.88 | $426.58 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $213.80
| Facility | 26 | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $676.08 / $691.83 / $691.83
| Facility | TC | $676.08 | $691.83 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $380.19 / $1,584.89
| Professional | | $218.78 | $380.19 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $64.57 / $891.25
| Professional | 26 | $36.31 | $64.57 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $302.00 / $1,380.38
| Professional | TC | $169.82 | $302.00 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $446.68 / $489.78
| Professional | | $371.54 | $446.68 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $79.43 / $95.50
| Professional | 26 | $67.61 | $79.43 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $371.54 / $398.11
| Professional | TC | $302.00 | $371.54 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $467.74 / $524.81
| Professional | | $112.20 | $467.74 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $83.18 / $89.13
| Professional | 26 | $61.66 | $83.18 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $371.54 / $398.11 / $436.52
| Professional | TC | $371.54 | $398.11 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $2,818.38 / $7,943.28
| Facility | | $912.01 | $2,818.38 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $173.78 / $363.08
| Professional | | $34.67 | $173.78 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $549.54 / $676.08
| Facility | | $346.74 | $549.54 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $323.59 / $645.65
| Professional | | $199.53 | $323.59 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $58.88 / $131.83
| Professional | 26 | $35.48 | $58.88 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $269.15 / $446.68
| Professional | TC | $162.18 | $269.15 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $398.11
| Professional | | $338.84 | $338.84 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $69.18
| Professional | 26 | $58.88 | $58.88 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $281.84 / $281.84 / $331.13
| Professional | TC | $281.84 | $281.84 | $331.13 |