- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $707.95 / $1,513.56
| Facility | | $234.42 | $707.95 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $46.77 / $102.33
| Facility | 26 | $34.67 | $46.77 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $363.08 / $1,148.15
| Facility | TC | $194.98 | $363.08 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $281.84 / $602.56
| Professional | | $190.55 | $281.84 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $46.77 / $104.71
| Professional | 26 | $30.90 | $46.77 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $213.80
| Professional | 50 | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $223.87 / $446.68
| Professional | TC | $165.96 | $223.87 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $549.54 / $977.24
| Facility | | $223.87 | $549.54 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $41.69
| Facility | 26 | $41.69 | $41.69 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $229.09
| Facility | TC | $229.09 | $229.09 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $251.19 / $489.78
| Professional | | $173.78 | $251.19 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $39.81 / $72.44
| Professional | 26 | $29.51 | $39.81 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $213.80 / $416.87
| Professional | TC | $147.91 | $213.80 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $645.65 / $1,258.93
| Facility | | $309.03 | $645.65 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $47.86 / $128.82
| Facility | 26 | $9.12 | $47.86 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $245.47 / $741.31
| Facility | TC | $46.77 | $245.47 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $354.81 / $691.83
| Professional | | $223.87 | $354.81 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $47.86 / $102.33
| Professional | 26 | $31.62 | $47.86 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $316.23 / $602.56
| Professional | TC | $194.98 | $316.23 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $316.23 / $812.83
| Facility | | $37.15 | $316.23 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $338.84 / $676.08
| Professional | | $218.78 | $338.84 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $47.86 / $107.15
| Professional | 26 | $30.20 | $47.86 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $275.42 / $512.86
| Professional | TC | $186.21 | $275.42 | $512.86 |