- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $354.81 / $1,380.38
| Facility | | $302.00 | $354.81 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $50.12 / $56.23
| Facility | 26 | $19.95 | $50.12 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $144.54 / $316.23
| Professional | | $40.74 | $144.54 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $30.20 / $60.26
| Professional | 26 | $20.89 | $30.20 | $60.26 |
- 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
- $100.00 / $117.49 / $208.93
| Professional | TC | $100.00 | $117.49 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $154.88 / $707.95
| Professional | | $104.71 | $154.88 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $23.44 / $24.55
| Professional | 26 | $21.38 | $23.44 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $138.04 / $147.91
| Professional | TC | $123.03 | $138.04 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $831.76 / $1,230.27
| Facility | | $562.34 | $831.76 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $181.97 / $380.19
| Professional | | $141.25 | $181.97 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $27.54 / $47.86
| Professional | 26 | $19.95 | $27.54 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $120.23 / $158.49 / $316.23
| Professional | TC | $120.23 | $158.49 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $162.18 / $346.74
| Professional | | $138.04 | $162.18 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $23.99 / $50.12
| Professional | 26 | $20.42 | $23.99 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $117.49 / $138.04 / $295.12
| Professional | TC | $117.49 | $138.04 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $501.19 / $588.84
| Facility | | $426.58 | $501.19 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $263.03 / $478.63
| Professional | | $120.23 | $263.03 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $48.98 / $79.43
| Professional | 26 | $19.95 | $48.98 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $109.65 / $169.82 / $371.54
| Professional | TC | $109.65 | $169.82 | $371.54 |