- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $575.44 / $1,737.80
| Facility | | $275.42 | $575.44 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $199.53 / $1,412.54
| Facility | 26 | $107.15 | $199.53 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,148.15 / $1,819.70 / $1,819.70
| Facility | TC | $1,148.15 | $1,819.70 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $288.40 / $602.56
| Professional | | $190.55 | $288.40 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $44.67 / $102.33
| Professional | 26 | $33.88 | $44.67 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $234.42 / $501.19
| Professional | TC | $162.18 | $234.42 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,071.52 / $1,071.52
| Facility | | $1,071.52 | $1,071.52 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $389.05 / $741.31
| Professional | | $234.42 | $389.05 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $50.12 / $125.89
| Professional | 26 | $33.88 | $50.12 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $331.13 / $630.96
| Professional | TC | $199.53 | $331.13 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $363.08 / $812.83
| Facility | | $234.42 | $363.08 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $199.53 / $1,412.54
| Facility | 26 | $107.15 | $199.53 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $467.74 / $1,318.26 / $1,819.70
| Facility | TC | $467.74 | $1,318.26 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $630.96 / $977.24
| Professional | | $263.03 | $630.96 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $107.15 / $186.21
| Professional | 26 | $39.81 | $107.15 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $537.03 / $794.33
| Professional | TC | $234.42 | $537.03 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $977.24 / $1,318.26
| Professional | | $977.24 | $977.24 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $151.36 / $199.53
| Professional | 26 | $123.03 | $151.36 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $676.08 / $831.76 / $1,096.48
| Professional | TC | $676.08 | $831.76 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $354.81 / $645.65
| Facility | | $234.42 | $354.81 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $478.63 / $741.31
| Professional | | $251.19 | $478.63 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $51.29 / $138.04
| Professional | 26 | $36.31 | $51.29 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $288.40 / $630.96
| Professional | TC | $199.53 | $288.40 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $602.56 / $1,202.26
| Professional | | $316.23 | $602.56 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $109.65 / $234.42
| Professional | 26 | $38.90 | $109.65 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $281.84 / $489.78 / $977.24
| Professional | TC | $281.84 | $489.78 | $977.24 |