- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $446.68 / $602.56
| Facility | | $331.13 | $446.68 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $134.90 / $134.90 / $134.90
| Facility | 26 | $134.90 | $134.90 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $169.82 / $645.65
| Professional | | $93.33 | $169.82 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $54.95 / $112.20
| Professional | 26 | $21.38 | $54.95 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $107.15
| Professional | 52 | $83.18 | $83.18 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $69.18 / $100.00 / $223.87
| Professional | TC | $69.18 | $100.00 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $251.19 / $331.13
| Facility | | $213.80 | $251.19 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $138.04 / $257.04
| Professional | | $102.33 | $138.04 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $33.11 / $54.95
| Professional | 26 | $22.91 | $33.11 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $104.71 / $141.25
| Professional | TC | $72.44 | $104.71 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $436.52 / $575.44
| Facility | | $323.59 | $436.52 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $158.49 / $251.19
| Professional | | $100.00 | $158.49 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $38.90 / $58.88
| Professional | 26 | $23.99 | $38.90 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $120.23 / $199.53
| Professional | TC | $75.86 | $120.23 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $218.78
| Facility | | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $123.03 / $213.80
| Professional | | $85.11 | $123.03 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $31.62 / $51.29
| Professional | 26 | $24.55 | $31.62 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $97.72 / $162.18
| Professional | TC | $56.23 | $97.72 | $162.18 |