- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $660.69 / $831.76
| Facility | | $169.82 | $660.69 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $44.67 / $46.77
| Facility | 26 | $37.15 | $44.67 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $181.97 / $389.05
| Professional | | $138.04 | $181.97 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $52.48 / $114.82
| Professional | 26 | $37.15 | $52.48 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $169.82 / $194.98 / $218.78
| Professional | 52 | $169.82 | $194.98 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $131.83 / $263.03
| Professional | TC | $100.00 | $131.83 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $138.04 / $169.82
| Professional | | $38.02 | $138.04 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $42.66 / $48.98
| Professional | 26 | $38.02 | $42.66 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $97.72 / $154.88
| Professional | TC | $97.72 | $97.72 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $239.88 / $426.58
| Professional | | $125.89 | $239.88 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $64.57 / $112.20
| Professional | 26 | $36.31 | $64.57 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $173.78 / $316.23
| Professional | TC | $87.10 | $173.78 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $162.18 / $245.47
| Professional | | $112.20 | $162.18 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $42.66 / $63.10
| Professional | 26 | $30.20 | $42.66 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $120.23 / $177.83
| Professional | TC | $83.18 | $120.23 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $112.20 / $288.40
| Facility | | $43.65 | $112.20 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $218.78 / $416.87
| Professional | | $147.91 | $218.78 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $58.88 / $104.71
| Professional | 26 | $35.48 | $58.88 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $109.65 / $162.18 / $309.03
| Professional | TC | $109.65 | $162.18 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $151.36 / $234.42
| Professional | | $134.90 | $151.36 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $39.81 / $60.26
| Professional | 26 | $38.90 | $39.81 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $109.65 / $173.78
| Professional | TC | $95.50 | $109.65 | $173.78 |