- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $831.76 / $1,202.26
| Facility | | $199.53 | $831.76 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $38.90
| Facility | 26 | $38.90 | $38.90 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $218.78 / $436.52
| Professional | | $165.96 | $218.78 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $47.86 / $120.23
| Professional | 26 | $34.67 | $47.86 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $131.83 / $162.18 / $302.00
| Professional | TC | $131.83 | $162.18 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $575.44 / $1,737.80
| Facility | | $316.23 | $575.44 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $30.90 / $30.90
| Facility | 26 | $25.70 | $30.90 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $457.09 / $645.65
| Professional | | $281.84 | $457.09 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $95.50 / $138.04
| Professional | 26 | $57.54 | $95.50 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $239.88 / $398.11 / $524.81
| Professional | TC | $239.88 | $398.11 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $691.83 / $1,621.81
| Facility | | $478.63 | $691.83 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $131.83 / $316.23
| Facility | 26 | $63.10 | $131.83 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $478.63 / $776.25
| Professional | | $218.78 | $478.63 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $93.33 / $154.88
| Professional | 26 | $38.90 | $93.33 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $181.97 / $389.05 / $616.60
| Professional | TC | $181.97 | $389.05 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $645.65 / $1,288.25
| Facility | | $524.81 | $645.65 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $128.82 / $251.19
| Facility | 26 | $104.71 | $128.82 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $457.09 / $707.95
| Professional | | $316.23 | $457.09 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $91.20 / $141.25
| Professional | 26 | $61.66 | $91.20 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $363.08 / $575.44
| Professional | TC | $251.19 | $363.08 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $323.59 / $575.44
| Facility | | $177.83 | $323.59 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $173.78
| Facility | 26 | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $371.54 / $1,445.44
| Professional | | $190.55 | $371.54 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $74.13 / $363.08
| Professional | 26 | $38.90 | $74.13 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $288.40 / $1,288.25
| Professional | TC | $151.36 | $288.40 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $602.56 / $851.14
| Facility | | $37.15 | $602.56 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $501.19 / $537.03
| Professional | | $204.17 | $501.19 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $104.71 / $104.71
| Professional | 26 | $41.69 | $104.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $281.84 / $489.78
| Professional | TC | $151.36 | $281.84 | $489.78 |