- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $562.34 / $758.58
| Facility | | $117.49 | $562.34 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $45.71 / $77.62
| Facility | 26 | $34.67 | $45.71 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $457.09 / $562.34
| Facility | TC | $208.93 | $457.09 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $50.12 / $123.03
| Professional | | $26.92 | $50.12 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $14.45 / $37.15
| Professional | 26 | $8.91 | $14.45 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $50.12 / $95.50
| Professional | TC | $19.95 | $50.12 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $467.74
| Facility | | $467.74 | $467.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $61.66 / $117.49
| Professional | | $41.69 | $61.66 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $18.20 / $37.15
| Professional | 26 | $12.88 | $18.20 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $41.69 / $81.28
| Professional | TC | $28.84 | $41.69 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $75.86 / $691.83
| Facility | | $34.67 | $75.86 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $45.71 / $77.62
| Facility | 26 | $34.67 | $45.71 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $407.38 / $616.60
| Facility | TC | $81.28 | $407.38 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $100.00 / $165.96
| Professional | | $40.74 | $100.00 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $30.90 / $57.54
| Professional | 26 | $10.96 | $30.90 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $74.13 / $128.82
| Professional | TC | $30.20 | $74.13 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $162.18 / $234.42
| Professional | | $151.36 | $162.18 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $43.65 / $72.44
| Professional | 26 | $39.81 | $43.65 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $117.49 / $165.96
| Professional | TC | $87.10 | $117.49 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $54.95 / $95.50
| Facility | | $33.11 | $54.95 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $97.72 / $117.49
| Professional | | $43.65 | $97.72 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $15.14 / $39.81
| Professional | 26 | $9.12 | $15.14 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $33.88 / $81.28
| Professional | TC | $23.44 | $33.88 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $91.20 / $199.53
| Professional | | $46.77 | $91.20 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $31.62 / $72.44
| Professional | 26 | $12.02 | $31.62 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $60.26 / $128.82
| Professional | TC | $33.88 | $60.26 | $128.82 |