- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $549.54 / $588.84
| Facility | | $338.84 | $549.54 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $575.44 / $575.44 / $602.56
| Facility | 26 | $575.44 | $575.44 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $75.86 / $204.17
| Professional | | $38.90 | $75.86 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $38.02 / $97.72
| Professional | 26 | $26.92 | $38.02 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $54.95 / $147.91 / $331.13
| Professional | 50 | $54.95 | $147.91 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $22.39 / $22.39 / $22.39
| Professional | 52 | $22.39 | $22.39 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.49 / $28.18 / $125.89
| Professional | TC | $15.49 | $28.18 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $46.77 / $52.48
| Professional | | $18.20 | $46.77 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $31.62 / $32.36
| Professional | 26 | $24.55 | $31.62 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $19.95 / $25.12
| Professional | TC | $18.20 | $19.95 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $74.13 / $100.00
| Facility | | $74.13 | $74.13 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $47.86
| Facility | 26 | $47.86 | $47.86 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $91.20 / $144.54
| Professional | | $43.65 | $91.20 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $35.48 / $67.61
| Professional | 26 | $21.88 | $35.48 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $51.29 / $87.10
| Professional | TC | $15.14 | $51.29 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $58.88 / $109.65
| Professional | | $51.29 | $58.88 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $35.48 / $47.86
| Professional | 26 | $30.90 | $35.48 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $22.39 / $63.10
| Professional | TC | $19.50 | $22.39 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $52.48 / $91.20
| Facility | | $24.55 | $52.48 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $79.43 / $134.90
| Professional | | $54.95 | $79.43 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $33.88 / $64.57
| Professional | 26 | $23.44 | $33.88 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $45.71 / $77.62
| Professional | TC | $28.18 | $45.71 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $63.10 / $74.13
| Professional | | $47.86 | $63.10 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $38.02 / $45.71
| Professional | 26 | $30.20 | $38.02 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $24.55 / $28.84
| Professional | TC | $18.20 | $24.55 | $28.84 |