- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $323.59 / $660.69
| Facility | | $40.74 | $323.59 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $28.84 / $28.84
| Facility | 26 | $28.84 | $28.84 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $144.54 / $323.59
| Professional | | $44.67 | $144.54 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $35.48 / $67.61
| Professional | 26 | $20.89 | $35.48 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $50.12
| Professional | 50 | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $123.03 / $218.78
| Professional | TC | $95.50 | $123.03 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $102.33 / $123.03
| Professional | | $95.50 | $102.33 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $22.39 / $27.54
| Professional | 26 | $16.60 | $22.39 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $95.50
| Professional | TC | $81.28 | $81.28 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $181.97 / $245.47
| Facility | | $151.36 | $181.97 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $144.54 / $158.49
| Professional | | $100.00 | $144.54 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $23.99 / $26.30
| Professional | 26 | $16.60 | $23.99 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $120.23 / $131.83
| Professional | TC | $83.18 | $120.23 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $162.18 / $3,162.28
| Facility | | $112.20 | $162.18 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $173.78 / $407.38
| Professional | | $109.65 | $173.78 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $26.92 / $69.18
| Professional | 26 | $19.05 | $26.92 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $107.15 / $165.96 / $371.54
| Professional | TC | $107.15 | $165.96 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $120.23 / $147.91
| Facility | | $17.78 | $120.23 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $151.36 / $275.42
| Professional | | $114.82 | $151.36 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $22.91 / $38.90
| Professional | 26 | $18.20 | $22.91 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $125.89 / $223.87
| Professional | TC | $95.50 | $125.89 | $223.87 |