- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $741.31 / $776.25
| Facility | | $181.97 | $741.31 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $331.13
| Facility | TC | $263.03 | $263.03 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $79.43 / $169.82
| Professional | | $43.65 | $79.43 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $33.88 / $93.33
| Professional | 26 | $10.72 | $33.88 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $70.79 / $173.78
| Professional | TC | $46.77 | $70.79 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $109.65
| Facility | | $109.65 | $109.65 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $74.13 / $144.54
| Professional | | $36.31 | $74.13 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.75 / $10.00 / $20.42
| Professional | 26 | $5.75 | $10.00 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $64.57 / $125.89
| Professional | TC | $30.90 | $64.57 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $162.18 / $229.09
| Professional | | $79.43 | $162.18 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $22.39 / $32.36
| Professional | 26 | $11.22 | $22.39 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $69.18 / $138.04 / $199.53
| Professional | TC | $69.18 | $138.04 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $117.49 / $741.31
| Facility | | $66.07 | $117.49 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $331.13
| Facility | TC | $263.03 | $263.03 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $131.83 / $263.03
| Professional | | $72.44 | $131.83 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $22.91 / $64.57
| Professional | 26 | $13.18 | $22.91 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $114.82 / $223.87
| Professional | TC | $60.26 | $114.82 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $114.82 / $162.18
| Facility | | $22.39 | $114.82 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $112.20 / $208.93
| Facility | | $66.07 | $112.20 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $141.25 / $245.47
| Professional | | $61.66 | $141.25 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.31 / $12.02 / $33.88
| Professional | 26 | $6.31 | $12.02 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $75.86 / $208.93
| Professional | TC | $31.62 | $75.86 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $144.54
| Facility | | $141.25 | $141.25 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $162.18 / $263.03
| Professional | | $114.82 | $162.18 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $24.55 / $37.15
| Professional | 26 | $16.98 | $24.55 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $138.04 / $229.09
| Professional | TC | $97.72 | $138.04 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $66.07 / $257.04
| Professional | | $46.77 | $66.07 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $12.59 / $38.90
| Professional | 26 | $7.59 | $12.59 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $64.57 / $218.78
| Professional | TC | $38.90 | $64.57 | $218.78 |