- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $501.19 / $812.83
| Facility | | $104.71 | $501.19 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $51.29 / $162.18
| Facility | 26 | $33.11 | $51.29 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $234.42 / $741.31
| Facility | TC | $70.79 | $234.42 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $107.15 / $213.80
| Professional | | $72.44 | $107.15 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $38.02 / $69.18
| Professional | 26 | $23.99 | $38.02 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $70.79 / $147.91
| Professional | TC | $48.98 | $70.79 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $398.11 / $436.52
| Facility | | $316.23 | $398.11 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $123.03 / $186.21
| Professional | | $87.10 | $123.03 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $39.81 / $60.26
| Professional | 26 | $27.54 | $39.81 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $83.18 / $125.89
| Professional | TC | $58.88 | $83.18 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $131.83 / $218.78
| Professional | | $81.28 | $131.83 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $40.74 / $66.07
| Professional | 26 | $27.54 | $40.74 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $91.20 / $151.36
| Professional | TC | $64.57 | $91.20 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $100.00 / $134.90
| Professional | | $72.44 | $100.00 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $134.90 / $245.47
| Professional | | $104.71 | $134.90 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $42.66 / $77.62
| Professional | 26 | $32.36 | $42.66 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $69.18 / $89.13 / $165.96
| Professional | TC | $69.18 | $89.13 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $12,302.69
| Facility | | $102.33 | $102.33 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $3,890.45
| Facility | 26 | $32.36 | $33.11 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $69.18 / $70.79 / $8,317.64
| Facility | TC | $69.18 | $70.79 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $112.20 / $208.93
| Professional | | $81.28 | $112.20 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $36.31 / $66.07
| Professional | 26 | $25.12 | $36.31 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $79.43 / $144.54
| Professional | TC | $52.48 | $79.43 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $128.82 / $331.13
| Professional | | $89.13 | $128.82 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $44.67 / $95.50
| Professional | 26 | $28.18 | $44.67 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $89.13 / $162.18
| Professional | TC | $61.66 | $89.13 | $162.18 |