- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $204.17 / $389.05
| Facility | | $83.18 | $204.17 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $43.65 / $57.54
| Facility | 26 | $40.74 | $43.65 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $93.33 / $398.11
| Professional | | $64.57 | $93.33 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $40.74 / $177.83
| Professional | 26 | $25.70 | $40.74 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $100.00 / $234.42 / $645.65
| Professional | 50 | $100.00 | $234.42 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $56.23 / $147.91
| Professional | TC | $38.90 | $56.23 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $489.78 / $794.33
| Facility | | $138.04 | $489.78 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $58.88 / $95.50
| Professional | | $23.44 | $58.88 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $48.98 / $48.98
| Facility | | $48.98 | $48.98 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $107.15 / $147.91
| Professional | | $72.44 | $107.15 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $42.66 / $58.88
| Professional | 26 | $28.18 | $42.66 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $64.57 / $89.13
| Professional | TC | $43.65 | $64.57 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $97.72
| Professional | | $32.36 | $33.11 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $109.65 / $190.55
| Facility | | $70.79 | $109.65 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $128.82 / $194.98
| Professional | | $72.44 | $128.82 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $42.66 / $58.88
| Professional | 26 | $28.84 | $42.66 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $64.57 / $89.13
| Professional | TC | $43.65 | $64.57 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $123.03 / $380.19
| Facility | | $47.86 | $123.03 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $102.33 / $186.21
| Professional | | $85.11 | $102.33 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $40.74 / $77.62
| Professional | 26 | $33.11 | $40.74 | $77.62 |
- 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
- $52.48 / $64.57 / $107.15
| Professional | TC | $52.48 | $64.57 | $107.15 |