- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $257.04 / $602.56
| Facility | | $97.72 | $257.04 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $30.20 / $63.10
| Facility | 26 | $24.55 | $30.20 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $107.15 / $134.90 / $389.05
| Facility | TC | $107.15 | $134.90 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $125.89 / $269.15
| Professional | | $21.38 | $125.89 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $28.18 / $85.11
| Professional | 26 | $19.05 | $28.18 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $109.65 / $186.21
| Professional | TC | $87.10 | $109.65 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $102.33 / $125.89
| Professional | | $77.62 | $102.33 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $19.95 / $25.12
| Professional | 26 | $16.22 | $19.95 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $63.10 / $83.18
| Professional | TC | $53.70 | $63.10 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $234.42 / $371.54
| Facility | | $134.90 | $234.42 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $141.25 / $173.78
| Professional | | $131.83 | $141.25 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $26.92 / $32.36
| Professional | 26 | $23.99 | $26.92 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $107.15 / $114.82 / $141.25
| Professional | TC | $107.15 | $114.82 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $107.15 / $112.20
| Facility | | $39.81 | $107.15 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $89.13 / $91.20
| Facility | TC | $39.81 | $89.13 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $29.51 / $39.81
| Professional | 26 | $19.95 | $29.51 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $331.13 / $537.03
| Facility | | $199.53 | $331.13 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $141.25 / $229.09
| Professional | | $104.71 | $141.25 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $26.30 / $41.69
| Professional | 26 | $19.95 | $26.30 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $114.82 / $190.55
| Professional | TC | $87.10 | $114.82 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $158.49 / $281.84
| Facility | | $109.65 | $158.49 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $128.82 / $223.87
| Professional | | $100.00 | $128.82 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $22.91 / $39.81
| Professional | 26 | $18.62 | $22.91 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $102.33 / $186.21
| Professional | TC | $81.28 | $102.33 | $186.21 |