- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.98 / $66.07 / $181.97
| Facility | | $0.98 | $66.07 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $97.72
| Facility | 26 | $70.79 | $70.79 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $177.83 / $407.38
| Professional | | $102.33 | $177.83 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $85.11 / $173.78
| Professional | 26 | $48.98 | $85.11 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $125.89
| Professional | 52 | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $87.10 / $257.04
| Professional | TC | $58.88 | $87.10 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $147.91 / $181.97
| Professional | | $70.79 | $147.91 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $77.62 / $87.10
| Professional | 26 | $72.44 | $77.62 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $74.13 / $87.10
| Professional | TC | $66.07 | $74.13 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $676.08
| Facility | | $234.42 | $234.42 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $131.83
| Facility | 26 | $131.83 | $131.83 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $204.17 / $575.44
| Professional | | $117.49 | $204.17 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $75.86 / $151.36
| Professional | 26 | $47.86 | $75.86 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $114.82 / $501.19
| Professional | TC | $54.95 | $114.82 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $177.83 / $275.42
| Professional | | $158.49 | $177.83 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $91.20 / $125.89
| Professional | 26 | $74.13 | $91.20 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $85.11 / $173.78
| Professional | TC | $72.44 | $85.11 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $147.91 / $467.74
| Facility | | $41.69 | $147.91 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $218.78 / $446.68
| Professional | | $144.54 | $218.78 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $77.62 / $162.18
| Professional | 26 | $46.77 | $77.62 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $69.18 / $114.82 / $389.05
| Professional | TC | $69.18 | $114.82 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $169.82 / $239.88
| Professional | | $154.88 | $169.82 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $87.10 / $123.03
| Professional | 26 | $83.18 | $87.10 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $81.28 / $114.82
| Professional | TC | $70.79 | $81.28 | $114.82 |