- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $630.96 / $4,168.69
| Facility | | $257.04 | $630.96 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $177.83 / $354.81 / $707.95
| Facility | 26 | $177.83 | $354.81 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $588.84 / $977.24
| Facility | TC | $194.98 | $588.84 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $398.11 / $891.25
| Professional | | $302.00 | $398.11 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $141.25 / $181.97 / $512.86
| Professional | 26 | $141.25 | $181.97 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $218.78 / $524.81
| Professional | TC | $151.36 | $218.78 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $436.52 / $1,202.26
| Professional | | $173.78 | $436.52 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $173.78 / $407.38
| Professional | 26 | $74.13 | $173.78 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $316.23 / $776.25
| Professional | TC | $100.00 | $316.23 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $851.14 / $2,754.23
| Facility | | $281.84 | $851.14 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $213.80 / $741.31
| Facility | 26 | $39.81 | $213.80 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $239.88 / $851.14
| Facility | TC | $44.67 | $239.88 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $524.81
| Professional | | $331.13 | $331.13 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $154.88 / $154.88 / $245.47
| Professional | 26 | $154.88 | $154.88 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $281.84
| Professional | TC | $173.78 | $173.78 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $229.09 / $407.38
| Facility | | $100.00 | $229.09 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $398.11 / $933.25
| Professional | | $204.17 | $398.11 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $186.21 / $416.87
| Professional | 26 | $102.33 | $186.21 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $223.87 / $537.03
| Professional | TC | $97.72 | $223.87 | $537.03 |