- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $630.96 / $660.69
| Facility | | $331.13 | $630.96 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $144.54 / $407.38
| Professional | | $67.61 | $144.54 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $63.10 / $275.42
| Professional | 26 | $28.84 | $63.10 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $66.07 / $181.97
| Professional | TC | $43.65 | $66.07 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $51.29
| Professional | | $46.77 | $46.77 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $31.62 / $52.48
| Professional | 26 | $14.45 | $31.62 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $69.18
| Professional | TC | $34.67 | $34.67 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $112.20 / $181.97
| Professional | | $85.11 | $112.20 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $56.23 / $81.28
| Professional | 26 | $31.62 | $56.23 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $69.18 / $107.15
| Professional | TC | $47.86 | $69.18 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $112.20 / $177.83
| Professional | | $102.33 | $112.20 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $41.69 / $79.43
| Professional | 26 | $31.62 | $41.69 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $70.79 / $123.03
| Professional | TC | $60.26 | $70.79 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $56.23 / $234.42
| Professional | | $46.77 | $56.23 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $28.84 / $114.82
| Professional | 26 | $16.60 | $28.84 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $36.31 / $114.82
| Professional | TC | $27.54 | $36.31 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $109.65 / $218.78
| Facility | | $79.43 | $109.65 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $169.82
| Facility | 26 | $169.82 | $169.82 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $354.81 / $354.81 / $354.81
| Facility | TC | $354.81 | $354.81 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $134.90 / $660.69
| Professional | | $64.57 | $134.90 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $47.86 / $275.42
| Professional | 26 | $22.91 | $47.86 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $85.11 / $426.58
| Professional | TC | $42.66 | $85.11 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $38.02 / $54.95
| Facility | | $16.22 | $38.02 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $104.71 / $213.80
| Professional | | $64.57 | $104.71 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $37.15 / $74.13
| Professional | 26 | $21.88 | $37.15 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $67.61 / $138.04
| Professional | TC | $42.66 | $67.61 | $138.04 |