- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $380.19 / $489.78
| Facility | | $81.28 | $380.19 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $66.07 / $72.44
| Facility | 26 | $53.70 | $66.07 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $107.15 / $288.40
| Professional | | $77.62 | $107.15 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $19.95 / $64.57
| Professional | 26 | $12.02 | $19.95 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $85.11 / $186.21
| Professional | TC | $63.10 | $85.11 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $79.43
| Professional | | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $15.49 / $15.49
| Professional | 26 | $15.49 | $15.49 | $15.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $251.19 / $478.63
| Facility | | $58.88 | $251.19 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $107.15 / $436.52
| Professional | | $89.13 | $107.15 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $15.14 / $58.88
| Professional | 26 | $12.30 | $15.14 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $91.20 / $371.54
| Professional | TC | $77.62 | $91.20 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $380.19 / $724.44
| Facility | | $218.78 | $380.19 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.80 / $17.78 / $25.12
| Facility | 26 | $3.80 | $17.78 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $104.71 / $199.53
| Professional | | $75.86 | $104.71 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $18.62 / $33.88
| Professional | 26 | $13.18 | $18.62 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $85.11 / $169.82
| Professional | TC | $63.10 | $85.11 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $114.82 / $218.78
| Facility | | $85.11 | $114.82 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $100.00 / $100.00
| Facility | 26 | $36.31 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $100.00 / $691.83
| Professional | | $81.28 | $100.00 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $17.78 / $151.36
| Professional | 26 | $15.49 | $17.78 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $83.18 / $588.84
| Professional | TC | $66.07 | $83.18 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $204.17 / $281.84
| Facility | | $43.65 | $204.17 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $100.00 / $213.80
| Professional | | $81.28 | $100.00 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $16.98 / $43.65
| Professional | 26 | $15.14 | $16.98 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $83.18 / $131.83
| Professional | TC | $64.57 | $83.18 | $131.83 |