- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $436.52 / $1,513.56
| Facility | | $144.54 | $436.52 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $56.23 / $151.36
| Facility | 26 | $30.90 | $56.23 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $162.18 / $562.34
| Professional | | $107.15 | $162.18 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $77.62 / $398.11
| Professional | 26 | $28.18 | $77.62 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $107.15 / $275.42
| Professional | TC | $70.79 | $107.15 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $117.49 / $346.74
| Professional | | $70.79 | $117.49 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $33.11 / $93.33
| Professional | 26 | $16.60 | $33.11 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $83.18 / $269.15
| Professional | TC | $54.95 | $83.18 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $457.09 / $1,318.26
| Facility | | $117.49 | $457.09 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $147.91 / $257.04
| Facility | 26 | $26.92 | $147.91 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $131.83 / $302.00
| Professional | | $58.88 | $131.83 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $36.31 / $74.13
| Professional | 26 | $18.62 | $36.31 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $91.20 / $234.42
| Professional | TC | $38.90 | $91.20 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $83.18 / $158.49
| Facility | | $25.70 | $83.18 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $158.49 / $389.05
| Professional | | $85.11 | $158.49 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $39.81 / $107.15
| Professional | 26 | $22.91 | $39.81 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $117.49 / $269.15
| Professional | TC | $61.66 | $117.49 | $269.15 |