- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $186.21 / $758.58
| Facility | | $97.72 | $186.21 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $41.69 / $77.62
| Facility | 26 | $36.31 | $41.69 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $194.98 / $724.44
| Facility | TC | $83.18 | $194.98 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $123.03 / $234.42
| Professional | | $83.18 | $123.03 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $39.81 / $81.28
| Professional | 26 | $27.54 | $39.81 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $81.28 / $138.04
| Professional | TC | $60.26 | $81.28 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $77.62 / $194.98
| Professional | | $66.07 | $77.62 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $26.30 / $37.15
| Professional | 26 | $25.70 | $26.30 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $56.23 / $85.11
| Professional | TC | $44.67 | $56.23 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $144.54 / $151.36
| Facility | | $87.10 | $144.54 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $173.78
| Professional | | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $138.04 / $239.88
| Facility | | $125.89 | $138.04 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $128.82 / $208.93
| Professional | | $85.11 | $128.82 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $38.02 / $77.62
| Professional | 26 | $28.84 | $38.02 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $57.54 / $93.33 / $154.88
| Professional | TC | $57.54 | $93.33 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $138.04 / $245.47
| Facility | | $107.15 | $138.04 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $158.49 / $158.49
| Facility | 26 | $83.18 | $158.49 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $331.13 / $1,071.52
| Facility | TC | $154.88 | $331.13 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $147.91 / $707.95
| Professional | | $112.20 | $147.91 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $46.77 / $288.40
| Professional | 26 | $35.48 | $46.77 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $102.33 / $478.63
| Professional | TC | $74.13 | $102.33 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $83.18 / $208.93
| Facility | | $75.86 | $83.18 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $125.89 / $204.17
| Professional | | $112.20 | $125.89 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $40.74 / $67.61
| Professional | 26 | $35.48 | $40.74 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $89.13 / $138.04
| Professional | TC | $75.86 | $89.13 | $138.04 |