- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $512.86 / $1,047.13
| Facility | | $95.50 | $512.86 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $28.84 / $50.12
| Facility | 26 | $26.92 | $28.84 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $128.82 / $467.74
| Facility | TC | $53.70 | $128.82 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $125.89 / $489.78
| Professional | | $77.62 | $125.89 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $41.69 / $120.23
| Professional | 26 | $25.12 | $41.69 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $70.79 / $169.82
| Professional | TC | $48.98 | $70.79 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $70.79 / $117.49
| Professional | | $63.10 | $70.79 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $28.18 / $33.88
| Professional | 26 | $18.20 | $28.18 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $57.54 / $70.79
| Professional | TC | $33.11 | $57.54 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $95.50 / $138.04
| Professional | | $85.11 | $95.50 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $32.36 / $50.12
| Professional | 26 | $30.20 | $32.36 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $63.10 / $93.33
| Professional | TC | $53.70 | $63.10 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $61.66 / $109.65
| Facility | | $26.92 | $61.66 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $57.54 / $100.00
| Professional | | $28.18 | $57.54 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $134.90 / $208.93
| Facility | | $114.82 | $134.90 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $31.62 / $45.71
| Facility | 26 | $6.76 | $31.62 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.80 / $64.57 / $91.20
| Facility | TC | $13.80 | $64.57 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $125.89 / $407.38
| Professional | | $79.43 | $125.89 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $41.69 / $141.25
| Professional | 26 | $24.55 | $41.69 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $91.20 / $275.42
| Professional | TC | $52.48 | $91.20 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $39.81
| Professional | | $32.36 | $33.11 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $74.13 / $165.96
| Facility | | $26.30 | $74.13 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $95.50 / $154.88
| Professional | | $75.86 | $95.50 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $31.62 / $54.95
| Professional | 26 | $25.70 | $31.62 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $66.07 / $102.33
| Professional | TC | $48.98 | $66.07 | $102.33 |