- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $501.19 / $2,570.40
| Facility | | $158.49 | $501.19 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $46.77 / $53.70
| Facility | 26 | $41.69 | $46.77 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $190.55 / $346.74
| Professional | | $141.25 | $190.55 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $52.48 / $107.15
| Professional | 26 | $37.15 | $52.48 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $128.82 / $169.82 / $812.83
| Professional | 52 | $128.82 | $169.82 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $128.82 / $245.47
| Professional | TC | $100.00 | $128.82 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $128.82 / $165.96
| Professional | | $112.20 | $128.82 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $41.69 / $60.26
| Professional | 26 | $34.67 | $41.69 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $26.30 / $32.36 / $35.48
| Professional | 52 | $26.30 | $32.36 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $87.10 / $144.54
| Professional | TC | $63.10 | $87.10 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $154.88 / $239.88
| Facility | | $79.43 | $154.88 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $107.15 / $128.82
| Professional | | $83.18 | $107.15 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $251.19 / $562.34
| Facility | | $144.54 | $251.19 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $43.65 / $63.10
| Facility | 26 | $9.55 | $43.65 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $229.09 / $407.38
| Professional | | $128.82 | $229.09 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $64.57 / $117.49
| Professional | 26 | $37.15 | $64.57 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $165.96 / $302.00
| Professional | TC | $93.33 | $165.96 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $114.82 / $213.80
| Professional | | $85.11 | $114.82 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $31.62 / $61.66
| Professional | 26 | $23.99 | $31.62 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $83.18 / $151.36
| Professional | TC | $61.66 | $83.18 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $134.90
| Professional | | $32.36 | $33.11 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $251.19 / $263.03
| Facility | | $44.67 | $251.19 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $199.53 / $338.84
| Professional | | $128.82 | $199.53 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $54.95 / $95.50
| Professional | 26 | $34.67 | $54.95 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $144.54 / $239.88
| Professional | TC | $93.33 | $144.54 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $107.15 / $158.49
| Professional | | $107.15 | $107.15 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $41.69
| Professional | 26 | $31.62 | $31.62 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $74.13 / $114.82
| Professional | TC | $74.13 | $74.13 | $114.82 |