- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $416.87 / $933.25
| Facility | | $125.89 | $416.87 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $102.33 / $173.78
| Facility | 26 | $89.13 | $102.33 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $331.13 / $416.87 / $660.69
| Facility | TC | $331.13 | $416.87 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $97.72 / $263.03
| Professional | | $57.54 | $97.72 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $37.15 / $100.00
| Professional | 26 | $23.44 | $37.15 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $77.62 / $208.93
| Professional | TC | $47.86 | $77.62 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $467.74
| Facility | | $467.74 | $467.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $154.88 / $295.12
| Professional | | $93.33 | $154.88 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $46.77 / $95.50
| Professional | 26 | $23.44 | $46.77 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $95.50 / $204.17
| Professional | TC | $61.66 | $95.50 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $199.53 / $851.14
| Facility | | $77.62 | $199.53 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $102.33 / $173.78
| Facility | 26 | $89.13 | $102.33 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $501.19 / $794.33
| Facility | TC | $158.49 | $501.19 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $229.09 / $380.19
| Professional | | $89.13 | $229.09 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $79.43 / $138.04
| Professional | 26 | $28.84 | $79.43 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $158.49 / $234.42
| Professional | TC | $70.79 | $158.49 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $371.54 / $524.81
| Professional | | $354.81 | $371.54 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $117.49 / $169.82
| Professional | 26 | $104.71 | $117.49 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $251.19 / $354.81
| Professional | TC | $218.78 | $251.19 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $131.83 / $257.04
| Facility | | $75.86 | $131.83 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $165.96 / $269.15
| Professional | | $93.33 | $165.96 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $38.90 / $89.13
| Professional | 26 | $23.44 | $38.90 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $57.54 / $83.18 / $204.17
| Professional | TC | $57.54 | $83.18 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $229.09 / $467.74
| Professional | | $102.33 | $229.09 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $83.18 / $165.96
| Professional | 26 | $30.20 | $83.18 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $154.88 / $295.12
| Professional | TC | $70.79 | $154.88 | $295.12 |