- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $446.68 / $912.01
| Facility | | $131.83 | $446.68 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $22.39 / $28.18
| Facility | 26 | $19.95 | $22.39 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $158.49 / $316.23
| Professional | | $117.49 | $158.49 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $26.30 / $61.66
| Professional | 26 | $19.50 | $26.30 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $123.03 / $223.87
| Professional | TC | $97.72 | $123.03 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $102.33 / $165.96
| Professional | | $83.18 | $102.33 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $30.20 / $41.69
| Professional | 26 | $18.20 | $30.20 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $91.20 / $151.36
| Professional | TC | $79.43 | $91.20 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $154.88 / $269.15
| Professional | | $104.71 | $154.88 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $30.20 / $46.77
| Professional | 26 | $20.89 | $30.20 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $102.33 / $158.49 / $239.88
| Professional | TC | $102.33 | $158.49 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $281.84 / $389.05
| Facility | | $194.98 | $281.84 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $169.82 / $269.15
| Professional | | $120.23 | $169.82 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $27.54 / $42.66
| Professional | 26 | $20.89 | $27.54 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $104.71 / $144.54 / $234.42
| Professional | TC | $104.71 | $144.54 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $831.76 / $831.76
| Facility | | $831.76 | $831.76 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $144.54 / $177.83 / $177.83
| Facility | 26 | $144.54 | $177.83 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,096.48 / $1,202.26
| Professional | | $1,096.48 | $1,096.48 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $323.59 / $323.59 / $323.59
| Professional | 26 | $323.59 | $323.59 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $933.25 / $933.25 / $1,071.52
| Professional | TC | $933.25 | $933.25 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $114.82 / $165.96
| Facility | | $21.88 | $114.82 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $162.18 / $251.19
| Professional | | $120.23 | $162.18 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $26.30 / $43.65
| Professional | 26 | $20.42 | $26.30 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $138.04 / $208.93
| Professional | TC | $100.00 | $138.04 | $208.93 |