- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $457.09 / $1,445.44
| Facility | | $125.89 | $457.09 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $67.61 / $162.18
| Facility | 26 | $48.98 | $67.61 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $134.90 / $407.38 / $512.86
| Facility | TC | $134.90 | $407.38 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $131.83 / $288.40
| Professional | | $21.38 | $131.83 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $26.30 / $85.11
| Professional | 26 | $19.05 | $26.30 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $112.20 / $275.42
| Professional | TC | $87.10 | $112.20 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $467.74
| Facility | | $467.74 | $467.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $194.98 / $371.54
| Professional | | $125.89 | $194.98 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $34.67 / $70.79
| Professional | 26 | $21.88 | $34.67 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $104.71 / $162.18 / $309.03
| Professional | TC | $104.71 | $162.18 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $275.42 / $1,230.27
| Facility | | $117.49 | $275.42 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $75.86 / $162.18
| Facility | 26 | $48.98 | $75.86 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $134.90 / $407.38 / $1,202.26
| Facility | TC | $134.90 | $407.38 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $288.40 / $489.78
| Professional | | $107.15 | $288.40 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $58.88 / $102.33
| Professional | 26 | $21.88 | $58.88 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $112.20 / $257.04 / $380.19
| Professional | TC | $112.20 | $257.04 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $478.63 / $645.65
| Professional | | $478.63 | $478.63 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $83.18 / $114.82
| Professional | 26 | $70.79 | $83.18 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $398.11 / $537.03
| Professional | TC | $302.00 | $398.11 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $177.83 / $331.13
| Facility | | $117.49 | $177.83 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $234.42 / $363.08
| Professional | | $125.89 | $234.42 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $30.20 / $77.62
| Professional | 26 | $20.42 | $30.20 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $134.90 / $309.03
| Professional | TC | $93.33 | $134.90 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $288.40 / $575.44
| Professional | | $169.82 | $288.40 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $61.66 / $134.90
| Professional | 26 | $22.91 | $61.66 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $134.90 / $223.87 / $457.09
| Professional | TC | $134.90 | $223.87 | $457.09 |