- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $467.74 / $1,513.56
| Facility | | $125.89 | $467.74 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $27.54 / $81.28
| Facility | 26 | $19.95 | $27.54 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $173.78 / $380.19
| Professional | | $114.82 | $173.78 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $29.51 / $64.57
| Professional | 26 | $19.95 | $29.51 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $123.03 / $263.03
| Professional | TC | $97.72 | $123.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $134.90 / $218.78
| Professional | | $91.20 | $134.90 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $31.62 / $40.74
| Professional | 26 | $17.78 | $31.62 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $81.28 / $91.20
| Professional | TC | $79.43 | $81.28 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $346.74 / $416.87
| Facility | | $141.25 | $346.74 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $194.98 / $309.03
| Professional | | $138.04 | $194.98 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $29.51 / $54.95
| Professional | 26 | $21.38 | $29.51 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $109.65 / $158.49 / $257.04
| Professional | TC | $109.65 | $158.49 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $138.04 / $199.53
| Facility | | $28.18 | $138.04 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $107.15 / $147.91
| Professional | | $20.89 | $107.15 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $269.15 / $338.84
| Facility | | $162.18 | $269.15 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $38.90
| Facility | 26 | $38.90 | $38.90 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $190.55 / $354.81
| Professional | | $125.89 | $190.55 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $29.51 / $54.95
| Professional | 26 | $21.38 | $29.51 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $107.15 / $165.96 / $309.03
| Professional | TC | $107.15 | $165.96 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $177.83 / $426.58
| Professional | | $134.90 | $177.83 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $29.51 / $97.72
| Professional | 26 | $21.88 | $29.51 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $128.82
| Professional | 52 | $85.11 | $85.11 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $114.82 / $147.91 / $380.19
| Professional | TC | $114.82 | $147.91 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $138.04 / $269.15
| Professional | | $25.12 | $138.04 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $131.83 / $371.54
| Facility | | $25.70 | $131.83 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $181.97 / $331.13
| Professional | | $125.89 | $181.97 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $28.18 / $52.48
| Professional | 26 | $21.38 | $28.18 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $104.71 / $158.49 / $281.84
| Professional | TC | $104.71 | $158.49 | $281.84 |