- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $309.03 / $660.69
| Facility | | $120.23 | $309.03 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $23.99 / $38.90
| Facility | 26 | $23.99 | $23.99 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $131.83 / $288.40
| Professional | | $107.15 | $131.83 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $23.99 / $57.54
| Professional | 26 | $20.89 | $23.99 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $107.15 / $204.17
| Professional | TC | $83.18 | $107.15 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $269.15 / $302.00
| Professional | | $204.17 | $269.15 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $53.70 / $58.88
| Professional | 26 | $39.81 | $53.70 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $218.78 / $239.88
| Professional | TC | $162.18 | $218.78 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $223.87 / $323.59
| Professional | | $123.03 | $223.87 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $41.69 / $60.26
| Professional | 26 | $24.55 | $41.69 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $177.83 / $263.03
| Professional | TC | $97.72 | $177.83 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $190.55 / $288.40
| Facility | | $123.03 | $190.55 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $229.09 / $1,023.29
| Professional | | $123.03 | $229.09 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $46.77 / $218.78
| Professional | 26 | $25.12 | $46.77 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $104.71 / $190.55 / $891.25
| Professional | TC | $104.71 | $190.55 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $208.93
| Facility | | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $204.17 / $295.12
| Professional | | $100.00 | $204.17 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $42.66 / $63.10
| Professional | 26 | $25.12 | $42.66 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $173.78 / $263.03
| Professional | TC | $97.72 | $173.78 | $263.03 |