- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $245.47 / $426.58
| Facility | | $77.62 | $245.47 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $41.69 / $47.86
| Facility | 26 | $37.15 | $41.69 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $89.13 / $213.80
| Professional | | $39.81 | $89.13 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $46.77 / $97.72
| Professional | 26 | $27.54 | $46.77 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $47.86 / $144.54 / $501.19
| Professional | 50 | $47.86 | $144.54 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $56.23 / $97.72
| Professional | TC | $39.81 | $56.23 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $79.43 / $81.28
| Professional | | $64.57 | $79.43 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $33.88 / $45.71
| Professional | 26 | $30.20 | $33.88 | $45.71 |
- 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
- $53.70 / $53.70 / $53.70
| Professional | TC | $53.70 | $53.70 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $128.82 / $181.97
| Facility | | $81.28 | $128.82 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $104.71 / $141.25
| Professional | | $89.13 | $104.71 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $41.69 / $58.88
| Professional | 26 | $35.48 | $41.69 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $63.10 / $83.18
| Professional | TC | $53.70 | $63.10 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $81.28
| Facility | | $66.07 | $66.07 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $33.88 / $33.88
| Professional | 26 | $30.20 | $33.88 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $181.97 / $251.19
| Facility | | $107.15 | $181.97 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $89.13 / $162.18
| Professional | | $58.88 | $89.13 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $36.31 / $69.18
| Professional | 26 | $22.91 | $36.31 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $53.70 / $100.00
| Professional | TC | $34.67 | $53.70 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $131.83 / $218.78
| Facility | | $64.57 | $131.83 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $87.10 / $138.04
| Professional | | $66.07 | $87.10 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $34.67 / $57.54
| Professional | 26 | $25.70 | $34.67 | $57.54 |
- 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
- $38.90 / $51.29 / $81.28
| Professional | TC | $38.90 | $51.29 | $81.28 |