- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $162.18 / $645.65
| Facility | | $154.88 | $162.18 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $125.89
| Facility | 26 | $81.28 | $81.28 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $173.78 / $346.74
| Professional | | $120.23 | $173.78 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $81.28 / $181.97
| Professional | 26 | $51.29 | $81.28 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $134.90
| Professional | 52 | $125.89 | $125.89 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $83.18 / $204.17
| Professional | TC | $56.23 | $83.18 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $478.63 / $758.58
| Facility | | $346.74 | $478.63 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $208.93 / $331.13
| Professional | | $154.88 | $208.93 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $102.33 / $158.49
| Professional | 26 | $74.13 | $102.33 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $100.00 / $181.97
| Professional | TC | $74.13 | $100.00 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $6,025.60 / $12,589.25
| Facility | | $123.03 | $6,025.60 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $165.96
| Facility | 26 | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $234.42 / $478.63
| Professional | | $138.04 | $234.42 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $87.10 / $173.78
| Professional | 26 | $52.48 | $87.10 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $128.82 / $346.74
| Professional | TC | $64.57 | $128.82 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $239.88 / $1,148.15
| Professional | | $218.78 | $239.88 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $125.89 / $239.88
| Professional | 26 | $114.82 | $125.89 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $104.71 / $114.82 / $912.01
| Professional | TC | $104.71 | $114.82 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $154.88 / $229.09
| Professional | | $144.54 | $154.88 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $81.28 / $128.82
| Professional | 26 | $77.62 | $81.28 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $72.44 / $102.33
| Professional | TC | $64.57 | $72.44 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $6,456.54 / $6,456.54
| Facility | | $208.93 | $6,456.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $269.15 / $436.52
| Professional | | $169.82 | $269.15 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $131.83 / $218.78
| Professional | 26 | $57.54 | $131.83 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $125.89 / $331.13
| Professional | TC | $74.13 | $125.89 | $331.13 |