- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $549.54 / $954.99
| Facility | | $72.44 | $549.54 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $16.60 / $56.23
| Facility | 26 | $10.00 | $16.60 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $95.50 / $229.09
| Professional | | $66.07 | $95.50 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $18.20 / $54.95
| Professional | 26 | $10.47 | $18.20 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $77.62 / $181.97
| Professional | TC | $56.23 | $77.62 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $177.83 / $213.80
| Professional | | $75.86 | $177.83 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $20.42 / $32.36
| Professional | 26 | $10.23 | $20.42 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $125.89 / $245.47
| Facility | | $60.26 | $125.89 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $79.43 / $93.33
| Professional | | $70.79 | $79.43 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $467.74 / $660.69
| Facility | | $158.49 | $467.74 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.80 / $17.78 / $30.20
| Facility | 26 | $3.80 | $17.78 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $91.20 / $199.53
| Professional | | $61.66 | $91.20 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $18.20 / $36.31
| Professional | 26 | $10.96 | $18.20 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $77.62 / $173.78
| Professional | TC | $52.48 | $77.62 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $158.49 / $346.74
| Facility | | $63.10 | $158.49 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $17.38 / $17.38
| Facility | 26 | $17.38 | $17.38 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $79.43 / $128.82
| Professional | | $64.57 | $79.43 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $15.49 / $22.91
| Professional | 26 | $10.96 | $15.49 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $51.29 / $64.57 / $102.33
| Professional | TC | $51.29 | $64.57 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $34.67 / $104.71
| Professional | | $9.12 | $34.67 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $186.21 / $489.78
| Facility | | $22.91 | $186.21 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $89.13 / $186.21
| Professional | | $66.07 | $89.13 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $15.85 / $33.11
| Professional | 26 | $12.59 | $15.85 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $70.79 / $138.04
| Professional | TC | $53.70 | $70.79 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $107.15
| Professional | | $53.70 | $53.70 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $8.13 / $16.22
| Professional | 26 | $8.13 | $8.13 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $91.20
| Professional | TC | $45.71 | $45.71 | $91.20 |