- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $281.84 / $676.08
| Facility | | $158.49 | $281.84 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $134.90 / $478.63
| Professional | | $104.71 | $134.90 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $138.04 / $407.38
| Professional | 26 | $53.70 | $138.04 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $69.18 / $85.11 / $181.97
| Professional | TC | $69.18 | $85.11 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $162.18 / $162.18
| Facility | | $162.18 | $162.18 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $151.36 / $288.40
| Professional | | $79.43 | $151.36 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $57.54 / $117.49
| Professional | 26 | $33.88 | $57.54 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $93.33 / $173.78
| Professional | TC | $44.67 | $93.33 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $331.13 / $478.63
| Professional | | $165.96 | $331.13 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $131.83 / $186.21
| Professional | 26 | $64.57 | $131.83 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $199.53 / $288.40
| Professional | TC | $100.00 | $199.53 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $208.93 / $407.38
| Facility | | $141.25 | $208.93 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $275.42 / $524.81
| Professional | | $141.25 | $275.42 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $125.89 / $223.87
| Professional | 26 | $70.79 | $125.89 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $165.96 / $309.03
| Professional | TC | $74.13 | $165.96 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $154.88 / $338.84
| Facility | | $112.20 | $154.88 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $218.78 / $416.87
| Facility | | $141.25 | $218.78 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $288.40 / $501.19
| Professional | | $120.23 | $288.40 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $70.79 / $199.53
| Professional | 26 | $37.15 | $70.79 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $102.33 / $302.00
| Professional | TC | $44.67 | $102.33 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $213.80
| Facility | | $208.93 | $208.93 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $316.23 / $537.03
| Professional | | $218.78 | $316.23 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $144.54 / $213.80
| Professional | 26 | $97.72 | $144.54 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $173.78 / $323.59
| Professional | TC | $123.03 | $173.78 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $134.90 / $501.19
| Professional | | $95.50 | $134.90 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $53.70 / $213.80
| Professional | 26 | $40.74 | $53.70 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $50.12 / $83.18 / $295.12
| Professional | TC | $50.12 | $83.18 | $295.12 |