- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $616.60 / $1,047.13
| Facility | | $95.50 | $616.60 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $21.88 / $32.36
| Facility | 26 | $19.95 | $21.88 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $190.55 / $912.01
| Facility | TC | $85.11 | $190.55 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $112.20 / $218.78
| Professional | | $25.12 | $112.20 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $27.54 / $64.57
| Professional | 26 | $19.95 | $27.54 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $107.15 / $173.78
| Professional | TC | $87.10 | $107.15 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $125.89 / $147.91
| Professional | | $85.11 | $125.89 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $23.44 / $26.30
| Professional | 26 | $16.60 | $23.44 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $112.20 / $112.20 / $112.20
| Professional | TC | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $416.87 / $588.84
| Facility | | $302.00 | $416.87 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $112.20 / $154.88
| Professional | | $20.89 | $112.20 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $407.38 / $407.38
| Facility | | $97.72 | $407.38 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $33.88
| Facility | 26 | $28.18 | $28.18 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $173.78
| Facility | TC | $158.49 | $158.49 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $165.96 / $218.78
| Professional | | $120.23 | $165.96 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $28.18 / $35.48
| Professional | 26 | $21.88 | $28.18 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $138.04 / $186.21
| Professional | TC | $97.72 | $138.04 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $158.49 / $426.58
| Facility | | $102.33 | $158.49 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $107.15 / $107.15
| Facility | 26 | $48.98 | $107.15 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $446.68 / $446.68
| Facility | TC | $194.98 | $446.68 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $144.54 / $1,047.13
| Professional | | $104.71 | $144.54 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $26.30 / $239.88
| Professional | 26 | $19.50 | $26.30 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $138.04 / $933.25
| Professional | TC | $87.10 | $138.04 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $165.96 / $269.15
| Facility | | $45.71 | $165.96 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $131.83 / $239.88
| Professional | | $95.50 | $131.83 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $23.99 / $45.71
| Professional | 26 | $18.62 | $23.99 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $104.71 / $199.53
| Professional | TC | $81.28 | $104.71 | $199.53 |