- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $436.52 / $1,047.13
| Facility | | $141.25 | $436.52 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $28.84 / $72.44
| Facility | 26 | $20.42 | $28.84 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $169.82 / $436.52
| Professional | | $114.82 | $169.82 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $28.84 / $67.61
| Professional | 26 | $19.95 | $28.84 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $123.03
| Professional | 52 | $123.03 | $123.03 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $131.83 / $263.03
| Professional | TC | $97.72 | $131.83 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $346.74 / $891.25
| Facility | | $128.82 | $346.74 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $24.55
| Facility | 26 | $24.55 | $24.55 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $173.78 / $323.59
| Professional | | $109.65 | $173.78 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $27.54 / $52.48
| Professional | 26 | $19.50 | $27.54 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $144.54 / $269.15
| Professional | TC | $95.50 | $144.54 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $371.54 / $794.33
| Facility | | $194.98 | $371.54 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.13 / $27.54 / $72.44
| Facility | 26 | $5.13 | $27.54 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $199.53 / $380.19
| Professional | | $125.89 | $199.53 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $30.90 / $60.26
| Professional | 26 | $20.89 | $30.90 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $107.15 / $173.78 / $323.59
| Professional | TC | $107.15 | $173.78 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $245.47 / $724.44
| Facility | | $26.92 | $245.47 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $177.83 / $323.59
| Professional | | $117.49 | $177.83 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $29.51 / $69.18
| Professional | 26 | $19.95 | $29.51 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $151.36 / $275.42
| Professional | TC | $100.00 | $151.36 | $275.42 |