- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $162.18 / $691.83
| Professional | | $120.23 | $162.18 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $72.44 / $316.23
| Professional | 26 | $28.18 | $72.44 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $125.89 / $309.03
| Professional | TC | $81.28 | $125.89 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $87.10 / $208.93
| Professional | | $75.86 | $87.10 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $63.10 / $169.82
| Professional | 26 | $17.38 | $63.10 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $61.66
| Professional | TC | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $95.50 / $338.84
| Professional | | $58.88 | $95.50 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $16.60 / $74.13
| Professional | 26 | $16.60 | $16.60 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $257.04
| Professional | TC | $54.95 | $54.95 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $165.96 / $316.23
| Facility | | $50.12 | $165.96 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $144.54 / $208.93
| Professional | | $42.66 | $144.54 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $134.90 / $512.86
| Professional | | $57.54 | $134.90 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $23.44 / $100.00
| Professional | 26 | $18.62 | $23.44 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $67.61 / $354.81
| Professional | TC | $37.15 | $67.61 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $263.03 / $524.81
| Professional | | $158.49 | $263.03 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $54.95 / $112.20
| Professional | 26 | $33.11 | $54.95 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $173.78 / $407.38
| Professional | TC | $125.89 | $173.78 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $162.18 / $323.59
| Professional | | $38.02 | $162.18 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $83.18 / $141.25
| Facility | | $42.66 | $83.18 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $147.91 / $363.08
| Professional | | $97.72 | $147.91 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $40.74 / $89.13
| Professional | 26 | $23.44 | $40.74 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $104.71 / $281.84
| Professional | TC | $74.13 | $104.71 | $281.84 |