- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $85.11 / $85.11
| Facility | | $77.62 | $85.11 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $23.99 / $23.99
| Facility | 26 | $21.38 | $23.99 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $70.79 / $131.83
| Professional | | $57.54 | $70.79 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $18.20 / $33.11
| Professional | 26 | $15.85 | $18.20 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $51.29 / $112.20
| Professional | TC | $40.74 | $51.29 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $67.61 / $104.71
| Facility | | $51.29 | $67.61 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $151.36
| Professional | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $812.83 / $1,023.29
| Facility | | $302.00 | $812.83 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $97.72 / $245.47
| Professional | | $61.66 | $97.72 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $23.99 / $39.81
| Professional | 26 | $17.78 | $23.99 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $45.71 / $72.44 / $190.55
| Professional | TC | $45.71 | $72.44 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $100.00 / $338.84
| Facility | | $60.26 | $100.00 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $41.69
| Facility | 26 | $41.69 | $41.69 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $125.89 / $812.83
| Professional | | $67.61 | $125.89 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $24.55 / $416.87
| Professional | 26 | $19.05 | $24.55 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $102.33 / $562.34
| Professional | TC | $48.98 | $102.33 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $389.05 / $398.11
| Facility | | $67.61 | $389.05 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $100.00 / $158.49
| Professional | | $67.61 | $100.00 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $22.91 / $38.02
| Professional | 26 | $19.05 | $22.91 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $70.79 / $123.03
| Professional | TC | $48.98 | $70.79 | $123.03 |