- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $323.59 / $1,122.02
| Facility | | $125.89 | $323.59 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $89.13 / $223.87
| Facility | 26 | $30.90 | $89.13 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $208.93 / $512.86
| Facility | TC | $72.44 | $208.93 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $147.91 / $323.59
| Professional | | $89.13 | $147.91 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $46.77 / $107.15
| Professional | 26 | $30.90 | $46.77 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $181.97
| Professional | 52 | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $81.28 / $229.09
| Professional | TC | $60.26 | $81.28 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $104.71 / $338.84
| Professional | | $37.15 | $104.71 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $38.90
| Professional | 26 | $33.11 | $33.11 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $100.00
| Professional | TC | $75.86 | $75.86 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $501.19 / $741.31
| Facility | | $338.84 | $501.19 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $134.90 / $309.03
| Professional | | $91.20 | $134.90 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $41.69 / $79.43
| Professional | 26 | $27.54 | $41.69 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $95.50 / $213.80
| Professional | TC | $61.66 | $95.50 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $123.03 / $257.04
| Professional | | $104.71 | $123.03 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $37.15 / $77.62
| Professional | 26 | $31.62 | $37.15 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $85.11 / $177.83
| Professional | TC | $72.44 | $85.11 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $501.19 / $588.84
| Facility | | $173.78 | $501.19 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $114.82 / $831.76
| Professional | | $95.50 | $114.82 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $95.50 / $218.78
| Professional | 26 | $31.62 | $95.50 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $95.50 / $501.19
| Professional | TC | $67.61 | $95.50 | $501.19 |