- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $660.69 / $933.25
| Facility | | $169.82 | $660.69 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $46.77
| Facility | 26 | $42.66 | $42.66 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $199.53 / $416.87
| Professional | | $138.04 | $199.53 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $57.54 / $165.96
| Professional | 26 | $38.90 | $57.54 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $218.78
| Professional | 52 | $169.82 | $169.82 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $102.33 / $138.04 / $275.42
| Professional | TC | $102.33 | $138.04 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $549.54 / $4,466.84
| Facility | | $208.93 | $549.54 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $33.88 / $33.88
| Facility | 26 | $28.18 | $33.88 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $331.13 / $457.09
| Professional | | $186.21 | $331.13 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $97.72 / $138.04
| Professional | 26 | $56.23 | $97.72 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $134.90 / $251.19 / $323.59
| Professional | TC | $134.90 | $251.19 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $524.81 / $1,230.27
| Facility | | $371.54 | $524.81 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $144.54 / $346.74
| Facility | 26 | $102.33 | $144.54 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $302.00 / $363.08
| Professional | | $281.84 | $302.00 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $83.18 / $100.00
| Professional | 26 | $77.62 | $83.18 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $199.53 / $239.88
| Professional | TC | $190.55 | $199.53 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $501.19 / $977.24
| Facility | | $398.11 | $501.19 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $138.04 / $269.15
| Facility | 26 | $109.65 | $138.04 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $281.84 / $354.81
| Professional | | $281.84 | $281.84 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $100.00
| Professional | 26 | $77.62 | $77.62 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $190.55 / $239.88
| Professional | TC | $190.55 | $190.55 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $295.12 / $870.96
| Facility | | $162.18 | $295.12 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $363.08 / $1,023.29
| Professional | | $177.83 | $363.08 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $97.72 / $263.03
| Professional | 26 | $47.86 | $97.72 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $234.42 / $602.56 / $977.24
| Professional | 52 | $234.42 | $602.56 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $239.88 / $776.25
| Professional | TC | $125.89 | $239.88 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $562.34 / $776.25
| Facility | | $549.54 | $562.34 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $323.59 / $537.03
| Professional | | $169.82 | $323.59 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $87.10 / $144.54
| Professional | 26 | $44.67 | $87.10 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $234.42 / $398.11
| Professional | TC | $125.89 | $234.42 | $398.11 |