- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $446.68 / $933.25
| Facility | | $95.50 | $446.68 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $70.79 / $208.93
| Facility | 26 | $28.84 | $70.79 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $87.10 / $218.78
| Professional | | $44.67 | $87.10 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $61.66 / $102.33
| Professional | 26 | $28.18 | $61.66 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $51.29 / $123.03 / $295.12
| Professional | 50 | $51.29 | $123.03 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $53.70 / $138.04
| Professional | TC | $42.66 | $53.70 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $89.13 / $245.47
| Professional | | $30.90 | $89.13 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $34.67 / $37.15
| Professional | 26 | $30.90 | $34.67 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $60.26 / $64.57
| Professional | TC | $53.70 | $60.26 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $436.52 / $524.81
| Facility | | $245.47 | $436.52 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $104.71 / $204.17
| Professional | | $67.61 | $104.71 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $38.90 / $74.13
| Professional | 26 | $25.70 | $38.90 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $64.57 / $128.82
| Professional | TC | $42.66 | $64.57 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $95.50 / $199.53
| Professional | | $81.28 | $95.50 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $33.88 / $70.79
| Professional | 26 | $28.84 | $33.88 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $61.66 / $128.82
| Professional | TC | $52.48 | $61.66 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $416.87 / $489.78
| Facility | | $128.82 | $416.87 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $95.50 / $512.86
| Professional | | $75.86 | $95.50 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $95.50 / $190.55
| Professional | 26 | $29.51 | $95.50 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $125.89
| Professional | 50 | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $91.20 / $316.23
| Professional | TC | $46.77 | $91.20 | $316.23 |