- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $630.96 / $794.33
| Facility | | $218.78 | $630.96 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $13.18 / $20.42
| Facility | 26 | $12.88 | $13.18 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $93.33 / $213.80
| Professional | | $75.86 | $93.33 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $18.20 / $91.20
| Professional | 26 | $12.88 | $18.20 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $77.62 / $128.82
| Professional | TC | $60.26 | $77.62 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $457.09 / $954.99
| Facility | | $186.21 | $457.09 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $104.71 / $165.96
| Professional | | $91.20 | $104.71 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $33.11 / $56.23
| Professional | 26 | $15.85 | $33.11 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $45.71 / $87.10 / $125.89
| Professional | TC | $45.71 | $87.10 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $660.69 / $1,202.26
| Facility | | $407.38 | $660.69 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $107.15 / $173.78
| Professional | | $79.43 | $107.15 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $21.38 / $33.88
| Professional | 26 | $15.85 | $21.38 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $85.11 / $141.25
| Professional | TC | $63.10 | $85.11 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $162.18 / $162.18
| Professional | | $162.18 | $162.18 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $30.90
| Professional | 26 | $30.90 | $30.90 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $120.23 / $208.93
| Facility | | $85.11 | $120.23 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $229.09 / $1,000.00
| Facility | | $177.83 | $229.09 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $104.71 / $190.55
| Professional | | $75.86 | $104.71 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $19.05 / $32.36
| Professional | 26 | $15.14 | $19.05 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $83.18 / $154.88
| Professional | TC | $61.66 | $83.18 | $154.88 |