- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $416.87 / $467.74
| Facility | | $204.17 | $416.87 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $34.67
| Facility | 26 | $34.67 | $34.67 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $75.86 / $275.42
| Professional | | $46.77 | $75.86 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $42.66 / $91.20
| Professional | 26 | $19.50 | $42.66 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $33.11 / $162.18
| Professional | TC | $25.12 | $33.11 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $44.67 / $83.18
| Facility | | $26.30 | $44.67 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $57.54 / $120.23
| Professional | | $25.12 | $57.54 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $104.71 / $104.71
| Facility | | $34.67 | $104.71 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $43.65 / $63.10
| Facility | 26 | $9.33 | $43.65 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $316.23 / $1,122.02
| Professional | | $61.66 | $316.23 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $128.82 / $489.78
| Professional | 26 | $35.48 | $128.82 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $173.78 / $446.68
| Professional | TC | $26.92 | $173.78 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $380.19 / $426.58
| Facility | | $380.19 | $380.19 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $75.86
| Professional | 26 | $72.44 | $72.44 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $363.08 / $457.09
| Facility | | $363.08 | $363.08 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $204.17 / $338.84
| Professional | | $51.29 | $204.17 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $79.43 / $131.83
| Professional | 26 | $30.90 | $79.43 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $128.82 / $218.78
| Professional | TC | $21.38 | $128.82 | $218.78 |