- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $1,047.13 / $1,621.81
| Facility | | $275.42 | $1,047.13 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $35.48 / $42.66
| Facility | 26 | $34.67 | $35.48 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $416.87 / $1,096.48
| Facility | TC | $162.18 | $416.87 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $251.19 / $870.96
| Professional | | $169.82 | $251.19 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $38.90 / $147.91
| Professional | 26 | $30.20 | $38.90 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $177.83 / $389.05
| Professional | TC | $141.25 | $177.83 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $147.91 / $218.78
| Professional | | $131.83 | $147.91 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $46.77 / $100.00
| Professional | 26 | $25.12 | $46.77 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $194.98 / $251.19
| Professional | | $186.21 | $194.98 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $33.88 / $44.67
| Professional | 26 | $33.88 | $33.88 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $162.18 / $204.17
| Professional | TC | $154.88 | $162.18 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $457.09 / $1,412.54
| Facility | | $346.74 | $457.09 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $269.15 / $389.05
| Professional | | $173.78 | $269.15 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $44.67 / $61.66
| Professional | 26 | $31.62 | $44.67 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $223.87 / $331.13
| Professional | TC | $154.88 | $223.87 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $181.97 / $309.03
| Professional | | $1.82 | $181.97 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.50 / $31.62 / $52.48
| Professional | 26 | $0.50 | $31.62 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1.29 / $151.36 / $245.47
| Professional | TC | $1.29 | $151.36 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $3.24 / $275.42
| Professional | | $3.24 | $3.24 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.89 / $0.89 / $47.86
| Professional | 26 | $0.89 | $0.89 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2.34 / $2.34 / $229.09
| Professional | TC | $2.34 | $2.34 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $181.97 / $295.12
| Professional | | $177.83 | $181.97 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $31.62 / $53.70
| Professional | 26 | $30.90 | $31.62 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $151.36 / $239.88
| Professional | TC | $147.91 | $151.36 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $194.98 / $281.84
| Facility | | $194.98 | $194.98 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $239.88 / $371.54
| Professional | | $162.18 | $239.88 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $41.69 / $69.18
| Professional | 26 | $30.90 | $41.69 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $144.54 / $223.87 / $323.59
| Professional | TC | $144.54 | $223.87 | $323.59 |