- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $549.54 / $741.31
| Facility | | $295.12 | $549.54 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $33.11 / $309.03
| Facility | 26 | $24.55 | $33.11 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $371.54 / $549.54
| Facility | TC | $70.79 | $371.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $123.03 / $467.74
| Professional | | $72.44 | $123.03 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $42.66 / $114.82
| Professional | 26 | $23.99 | $42.66 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $50.12 / $81.28 / $263.03
| Professional | TC | $50.12 | $81.28 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $87.10 / $109.65
| Professional | | $29.51 | $87.10 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $26.30 / $33.11
| Professional | 26 | $26.30 | $26.30 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $67.61 / $87.10
| Professional | TC | $60.26 | $67.61 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $102.33 / $134.90
| Facility | | $56.23 | $102.33 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $45.71
| Facility | 26 | $45.71 | $45.71 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $91.20 / $91.20 / $91.20
| Facility | TC | $91.20 | $91.20 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $104.71 / $186.21
| Professional | | $69.18 | $104.71 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $31.62 / $56.23
| Professional | 26 | $21.38 | $31.62 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $72.44 / $128.82
| Professional | TC | $47.86 | $72.44 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $107.15 / $151.36
| Professional | | $91.20 | $107.15 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $32.36 / $46.77
| Professional | 26 | $28.18 | $32.36 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $74.13 / $100.00
| Professional | TC | $63.10 | $74.13 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $53.70 / $102.33
| Facility | | $22.91 | $53.70 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $102.33 / $213.80
| Professional | | $74.13 | $102.33 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $31.62 / $70.79
| Professional | 26 | $22.91 | $31.62 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $51.29 / $72.44 / $144.54
| Professional | TC | $51.29 | $72.44 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $114.82 / $134.90
| Professional | | $75.86 | $114.82 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $33.88 / $41.69
| Professional | 26 | $23.99 | $33.88 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $79.43 / $93.33
| Professional | TC | $52.48 | $79.43 | $93.33 |