- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $501.19 / $1,584.89
| Facility | | $158.49 | $501.19 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $58.88 / $147.91
| Facility | 26 | $41.69 | $58.88 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $199.53 / $407.38
| Professional | | $141.25 | $199.53 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $54.95 / $128.82
| Professional | 26 | $38.02 | $54.95 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $91.20 / $190.55 / $234.42
| Professional | 52 | $91.20 | $190.55 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $131.83 / $239.88
| Professional | TC | $100.00 | $131.83 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $1,047.13 / $3,235.94
| Facility | | $251.19 | $1,047.13 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $213.80 / $363.08
| Professional | | $138.04 | $213.80 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $63.10 / $117.49
| Professional | 26 | $41.69 | $63.10 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $162.18 / $263.03
| Professional | TC | $93.33 | $162.18 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $380.19 / $1,230.27
| Facility | | $162.18 | $380.19 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $50.12 / $141.25
| Facility | 26 | $9.55 | $50.12 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $257.04 / $416.87
| Professional | | $144.54 | $257.04 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $72.44 / $112.20
| Professional | 26 | $40.74 | $72.44 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $102.33 / $186.21 / $302.00
| Professional | TC | $102.33 | $186.21 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $426.58 / $831.76
| Facility | | $151.36 | $426.58 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $213.80 / $389.05
| Professional | | $141.25 | $213.80 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $61.66 / $109.65
| Professional | 26 | $37.15 | $61.66 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $102.33 / $154.88 / $288.40
| Professional | TC | $102.33 | $154.88 | $288.40 |