- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $645.65 / $1,122.02
| Facility | | $263.03 | $645.65 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $39.81 / $66.07
| Facility | 26 | $38.90 | $39.81 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $134.90 / $331.13
| Professional | | $95.50 | $134.90 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $53.70 / $104.71
| Professional | 26 | $32.36 | $53.70 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $100.00 / $269.15
| Professional | TC | $64.57 | $100.00 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $269.15 / $295.12
| Professional | | $199.53 | $269.15 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $89.13 / $97.72
| Professional | 26 | $66.07 | $89.13 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $134.90 / $177.83 / $199.53
| Professional | TC | $134.90 | $177.83 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $186.21 / $288.40
| Professional | | $128.82 | $186.21 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $61.66 / $97.72
| Professional | 26 | $38.90 | $61.66 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $123.03 / $199.53
| Professional | TC | $77.62 | $123.03 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $190.55 / $398.11
| Facility | | $123.03 | $190.55 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $223.87 / $758.58
| Professional | | $125.89 | $223.87 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $75.86 / $302.00
| Professional | 26 | $44.67 | $75.86 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $151.36 / $512.86
| Professional | TC | $83.18 | $151.36 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $208.93
| Facility | | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $199.53 / $288.40
| Professional | | $100.00 | $199.53 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $69.18 / $102.33
| Professional | 26 | $40.74 | $69.18 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $131.83 / $194.98
| Professional | TC | $83.18 | $131.83 | $194.98 |