- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $134.90 / $831.76
| Facility | | $112.20 | $134.90 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $20.42 / $20.42
| Facility | 26 | $20.42 | $20.42 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $107.15 / $218.78
| Professional | | $70.79 | $107.15 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $23.99 / $58.88
| Professional | 26 | $12.88 | $23.99 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $87.10 / $169.82
| Professional | TC | $60.26 | $87.10 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $74.13 / $74.13
| Professional | | $74.13 | $74.13 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $16.98 / $19.05
| Professional | 26 | $16.98 | $16.98 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $194.98 / $269.15
| Facility | | $165.96 | $194.98 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $120.23 / $151.36
| Professional | | $83.18 | $120.23 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $35.48 / $45.71
| Professional | 26 | $25.12 | $35.48 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $83.18 / $107.15
| Professional | TC | $58.88 | $83.18 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $194.98 / $588.84
| Facility | | $123.03 | $194.98 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $18.62 / $19.05
| Facility | 26 | $18.62 | $18.62 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $97.72 / $213.80
| Professional | | $61.66 | $97.72 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $20.42 / $40.74
| Professional | 26 | $13.18 | $20.42 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $87.10 / $190.55
| Professional | TC | $58.88 | $87.10 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $371.54 / $467.74
| Facility | | $56.23 | $371.54 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $93.33 / $138.04
| Professional | | $64.57 | $93.33 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $16.22 / $32.36
| Professional | 26 | $12.59 | $16.22 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $75.86 / $102.33
| Professional | TC | $48.98 | $75.86 | $102.33 |