- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $616.60 / $870.96
| Facility | | $263.03 | $616.60 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $64.57
| Facility | 26 | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $380.19 / $478.63 / $616.60
| Facility | TC | $380.19 | $478.63 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $147.91 / $707.95
| Professional | | $23.99 | $147.91 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $38.02 / $114.82
| Professional | 26 | $19.95 | $38.02 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $131.83 / $269.15
| Professional | TC | $93.33 | $131.83 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $251.19 / $389.05
| Facility | | $213.80 | $251.19 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $147.91 / $223.87
| Professional | | $112.20 | $147.91 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $25.70 / $43.65
| Professional | 26 | $17.78 | $25.70 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $123.03 / $162.18
| Professional | TC | $85.11 | $123.03 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $501.19 / $575.44
| Facility | | $323.59 | $501.19 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $162.18 / $257.04
| Professional | | $109.65 | $162.18 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $29.51 / $45.71
| Professional | 26 | $20.42 | $29.51 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $141.25 / $208.93
| Professional | TC | $100.00 | $141.25 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $218.78
| Facility | | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $147.91 / $229.09
| Professional | | $114.82 | $147.91 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $26.92 / $42.66
| Professional | 26 | $20.89 | $26.92 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $128.82 / $190.55
| Professional | TC | $95.50 | $128.82 | $190.55 |