- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $398.11 / $954.99
| Facility | | $125.89 | $398.11 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $30.20 / $125.89
| Facility | 26 | $21.88 | $30.20 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $144.54 / $288.40
| Professional | | $43.65 | $144.54 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $30.90 / $61.66
| Professional | 26 | $20.42 | $30.90 | $61.66 |
- 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 / $245.47
| Professional | TC | $95.50 | $123.03 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $120.23 / $147.91
| Professional | | $97.72 | $120.23 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $21.38 / $42.66
| Professional | 26 | $16.98 | $21.38 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $35.48 / $72.44
| Professional | 26 | $24.55 | $35.48 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $562.34
| Facility | | $302.00 | $302.00 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $213.80 / $380.19
| Professional | | $138.04 | $213.80 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $28.18 / $51.29
| Professional | 26 | $19.50 | $28.18 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $114.82 / $181.97 / $323.59
| Professional | TC | $114.82 | $181.97 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $194.98 / $263.03
| Professional | | $154.88 | $194.98 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $32.36 / $44.67
| Professional | 26 | $25.70 | $32.36 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $128.82 / $162.18 / $218.78
| Professional | TC | $128.82 | $162.18 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $426.58 / $13,803.84
| Facility | | $125.89 | $426.58 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $158.49 / $288.40
| Professional | | $112.20 | $158.49 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $26.30 / $48.98
| Professional | 26 | $18.62 | $26.30 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $134.90 / $245.47
| Professional | TC | $93.33 | $134.90 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $154.88 / $436.52
| Facility | | $20.89 | $154.88 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $169.82 / $302.00
| Professional | | $112.20 | $169.82 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $25.12 / $45.71
| Professional | 26 | $16.22 | $25.12 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $144.54 / $257.04
| Professional | TC | $93.33 | $144.54 | $257.04 |