- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $229.09 / $870.96
| Facility | | $87.10 | $229.09 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $31.62 / $69.18
| Facility | 26 | $26.92 | $31.62 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $77.62 / $912.01
| Facility | TC | $58.88 | $77.62 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $102.33 / $251.19
| Professional | | $70.79 | $102.33 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $42.66 / $117.49
| Professional | 26 | $25.12 | $42.66 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $50.12 / $69.18 / $147.91
| Professional | TC | $50.12 | $69.18 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $194.98
| Facility | | $63.10 | $63.10 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $109.65 / $177.83
| Professional | | $66.07 | $109.65 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $33.11 / $56.23
| Professional | 26 | $20.42 | $33.11 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $75.86 / $125.89
| Professional | TC | $47.86 | $75.86 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $295.12 / $537.03
| Facility | | $123.03 | $295.12 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $537.03 / $537.03 / $537.03
| Facility | TC | $537.03 | $537.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $87.10 / $120.23
| Professional | | $85.11 | $87.10 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $34.67 / $295.12
| Professional | 26 | $26.92 | $34.67 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $97.72 / $436.52
| Professional | | $74.13 | $97.72 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $35.48 / $138.04
| Professional | 26 | $22.91 | $35.48 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $51.29 / $79.43 / $302.00
| Professional | TC | $51.29 | $79.43 | $302.00 |