- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $457.09 / $977.24
| Facility | | $138.04 | $457.09 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $21.88 / $54.95
| Facility | 26 | $15.14 | $21.88 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $107.15 / $239.88
| Professional | | $79.43 | $107.15 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $23.99 / $60.26
| Professional | 26 | $12.88 | $23.99 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $87.10 / $194.98
| Professional | TC | $64.57 | $87.10 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $15.14 / $19.95
| Professional | 26 | $15.14 | $15.14 | $19.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $616.60 / $630.96
| Facility | | $537.03 | $616.60 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $95.50 / $158.49
| Professional | | $70.79 | $95.50 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $22.39 / $36.31
| Professional | 26 | $16.98 | $22.39 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $70.79 / $123.03
| Professional | TC | $52.48 | $70.79 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $107.15 / $125.89
| Professional | | $107.15 | $107.15 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $16.98 / $19.95
| Professional | 26 | $16.98 | $16.98 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $107.15
| Professional | TC | $89.13 | $89.13 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $77.62 / $93.33
| Facility | | $14.79 | $77.62 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $371.54 / $794.33
| Facility | | $194.98 | $371.54 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $114.82 / $218.78
| Professional | | $75.86 | $114.82 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $20.89 / $36.31
| Professional | 26 | $13.80 | $20.89 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $95.50 / $186.21
| Professional | TC | $64.57 | $95.50 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $354.81 / $977.24
| Facility | | $83.18 | $354.81 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.80 / $17.78 / $25.12
| Facility | 26 | $3.80 | $17.78 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $112.20 / $190.55
| Professional | | $75.86 | $112.20 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $20.89 / $38.02
| Professional | 26 | $13.80 | $20.89 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $93.33 / $158.49
| Professional | TC | $64.57 | $93.33 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $295.12 / $295.12
| Facility | | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $295.12 / $295.12 / $295.12
| Facility | 26 | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $125.89 / $223.87
| Professional | | $102.33 | $125.89 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $19.95 / $35.48
| Professional | 26 | $16.22 | $19.95 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $107.15 / $190.55
| Professional | TC | $87.10 | $107.15 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $177.83 / $549.54
| Facility | | $19.05 | $177.83 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $97.72 / $181.97
| Professional | | $70.79 | $97.72 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $18.20 / $35.48
| Professional | 26 | $12.88 | $18.20 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $79.43 / $134.90
| Professional | TC | $54.95 | $79.43 | $134.90 |