- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $295.12 / $645.65
| Facility | | $93.33 | $295.12 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $25.70 / $123.03
| Facility | 26 | $23.99 | $25.70 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $50.12 / $208.93 / $407.38
| Facility | TC | $50.12 | $208.93 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $114.82 / $199.53
| Professional | | $72.44 | $114.82 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $38.02 / $70.79
| Professional | 26 | $25.12 | $38.02 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $66.07 / $117.49
| Professional | TC | $48.98 | $66.07 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $74.13 / $83.18
| Professional | | $50.12 | $74.13 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $26.30 / $39.81
| Professional | 26 | $22.39 | $26.30 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $51.29 / $60.26
| Professional | TC | $42.66 | $51.29 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $269.15
| Facility | | $239.88 | $239.88 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $141.25
| Professional | | $141.25 | $141.25 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $109.65 / $151.36
| Facility | | $93.33 | $109.65 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $114.82 / $177.83
| Professional | | $64.57 | $114.82 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $38.02 / $56.23
| Professional | 26 | $20.89 | $38.02 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $75.86 / $123.03
| Professional | TC | $42.66 | $75.86 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $43.65
| Professional | | $32.36 | $33.11 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $208.93 / $223.87
| Facility | | $131.83 | $208.93 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $93.33 / $158.49
| Professional | | $72.44 | $93.33 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $30.20 / $52.48
| Professional | 26 | $23.99 | $30.20 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $63.10 / $97.72
| Professional | TC | $47.86 | $63.10 | $97.72 |