- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $407.38 / $1,071.52
| Facility | | $151.36 | $407.38 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $53.70 / $58.88
| Facility | 26 | $43.65 | $53.70 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $181.97 / $407.38
| Professional | | $144.54 | $181.97 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $48.98 / $112.20
| Professional | 26 | $37.15 | $48.98 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $91.20 / $181.97 / $223.87
| Professional | 52 | $91.20 | $181.97 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $104.71 / $134.90 / $199.53
| Professional | TC | $104.71 | $134.90 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $114.82 / $173.78
| Professional | | $100.00 | $114.82 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $47.86 / $61.66
| Professional | 26 | $34.67 | $47.86 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.88
| Professional | 52 | $32.36 | $32.36 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $173.78
| Professional | TC | $81.28 | $81.28 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $204.17 / $338.84
| Professional | | $114.82 | $204.17 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $70.79 / $102.33
| Professional | 26 | $45.71 | $70.79 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $177.83 / $263.03
| Professional | TC | $125.89 | $177.83 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $309.03 / $1,584.89
| Facility | | $138.04 | $309.03 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $223.87 / $363.08
| Professional | | $138.04 | $223.87 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $63.10 / $102.33
| Professional | 26 | $40.74 | $63.10 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $158.49 / $251.19
| Professional | TC | $97.72 | $158.49 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,380.38 / $2,187.76
| Facility | | $1,023.29 | $1,380.38 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $257.04 / $257.04 / $257.04
| Facility | 26 | $257.04 | $257.04 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $2,187.76 / $2,187.76
| Professional | | $1,023.29 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $269.15 / $309.03 / $309.03
| Professional | 26 | $269.15 | $309.03 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $776.25 / $2,089.30 / $2,089.30
| Professional | TC | $776.25 | $2,089.30 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $389.05
| Facility | | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $213.80 / $331.13
| Professional | | $151.36 | $213.80 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $61.66 / $91.20
| Professional | 26 | $38.90 | $61.66 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $109.65 / $151.36 / $234.42
| Professional | TC | $109.65 | $151.36 | $234.42 |