- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $588.84 / $933.25
| Facility | | $97.72 | $588.84 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $29.51 / $42.66
| Facility | 26 | $25.70 | $29.51 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $190.55 / $234.42
| Professional | | $100.00 | $190.55 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $54.95 / $89.13
| Professional | 26 | $23.99 | $54.95 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $107.15
| Professional | 52 | $102.33 | $102.33 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $100.00 / $162.18
| Professional | TC | $70.79 | $100.00 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $89.13 / $147.91
| Facility | | $28.84 | $89.13 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $81.28 / $177.83
| Professional | | $26.92 | $81.28 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $169.82 / $269.15
| Facility | | $131.83 | $169.82 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.61 / $30.90 / $43.65
| Facility | 26 | $6.61 | $30.90 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $147.91 / $512.86
| Professional | | $87.10 | $147.91 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $38.02 / $131.83
| Professional | 26 | $21.88 | $38.02 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $107.15 / $389.05
| Professional | TC | $66.07 | $107.15 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $478.63 / $645.65
| Facility | | $257.04 | $478.63 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $501.19 / $501.19 / $501.19
| Facility | 26 | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $199.53 / $295.12
| Professional | | $190.55 | $199.53 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $46.77 / $72.44
| Professional | 26 | $42.66 | $46.77 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $128.82 / $141.25 / $154.88
| Professional | TC | $128.82 | $141.25 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $295.12 / $295.12
| Facility | | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $104.71 / $218.78
| Professional | | $70.79 | $104.71 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $28.18 / $57.54
| Professional | 26 | $19.50 | $28.18 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $77.62 / $151.36
| Professional | TC | $52.48 | $77.62 | $151.36 |