- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $588.84 / $851.14
| Facility | | $316.23 | $588.84 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $36.31 / $40.74
| Facility | 26 | $30.20 | $36.31 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $436.52 / $660.69
| Facility | TC | $66.07 | $436.52 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $165.96 / $588.84
| Professional | | $91.20 | $165.96 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $46.77 / $131.83
| Professional | 26 | $30.20 | $46.77 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $181.97
| Professional | 52 | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $95.50 / $263.03
| Professional | TC | $61.66 | $95.50 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $102.33 / $128.82
| Professional | | $37.15 | $102.33 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $41.69
| Professional | 26 | $33.11 | $33.11 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $85.11 / $107.15
| Professional | TC | $70.79 | $85.11 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $56.23 / $165.96
| Facility | | $56.23 | $56.23 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $56.23 / $56.23
| Facility | 26 | $56.23 | $56.23 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $112.20 / $112.20 / $112.20
| Facility | TC | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $131.83 / $229.09
| Professional | | $87.10 | $131.83 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $39.81 / $69.18
| Professional | 26 | $26.92 | $39.81 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $93.33 / $162.18
| Professional | TC | $58.88 | $93.33 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $131.83 / $190.55
| Professional | | $112.20 | $131.83 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $40.74 / $57.54
| Professional | 26 | $34.67 | $40.74 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $89.13 / $123.03
| Professional | TC | $74.13 | $89.13 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $69.18 / $125.89
| Facility | | $28.84 | $69.18 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $125.89 / $263.03
| Professional | | $93.33 | $125.89 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $39.81 / $85.11
| Professional | 26 | $28.84 | $39.81 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $89.13 / $181.97
| Professional | TC | $66.07 | $89.13 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $141.25 / $165.96
| Professional | | $97.72 | $141.25 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $42.66 / $51.29
| Professional | 26 | $30.90 | $42.66 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $97.72 / $114.82
| Professional | TC | $67.61 | $97.72 | $114.82 |