- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $467.74 / $831.76
| Facility | | $107.15 | $467.74 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $32.36 / $93.33
| Facility | 26 | $20.89 | $32.36 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $144.54 / $346.74
| Professional | | $44.67 | $144.54 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $30.20 / $69.18
| Professional | 26 | $20.89 | $30.20 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $50.12
| Professional | 50 | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $117.49 / $194.98
| Professional | TC | $97.72 | $117.49 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $190.55 / $281.84
| Professional | | $128.82 | $190.55 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $30.20 / $44.67
| Professional | 26 | $20.89 | $30.20 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $109.65 / $158.49 / $239.88
| Professional | TC | $109.65 | $158.49 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $162.18 / $588.84
| Professional | | $28.84 | $162.18 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $23.44 / $27.54
| Professional | 26 | $21.38 | $23.44 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $138.04 / $154.88
| Professional | TC | $123.03 | $138.04 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $524.81 / $870.96
| Facility | | $288.40 | $524.81 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.50 / $25.70 / $37.15
| Facility | 26 | $5.50 | $25.70 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $204.17 / $316.23
| Professional | | $138.04 | $204.17 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $27.54 / $47.86
| Professional | 26 | $21.38 | $27.54 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $117.49 / $177.83 / $281.84
| Professional | TC | $117.49 | $177.83 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $162.18 / $213.80
| Professional | | $128.82 | $162.18 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $23.99 / $32.36
| Professional | 26 | $19.50 | $23.99 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $109.65 / $138.04 / $186.21
| Professional | TC | $109.65 | $138.04 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $234.42 / $269.15
| Professional | | $190.55 | $234.42 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $31.62 / $31.62
| Professional | 26 | $25.70 | $31.62 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $181.97 / $316.23
| Facility | | $125.89 | $181.97 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $138.04
| Professional | | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $147.91 / $295.12
| Facility | | $24.55 | $147.91 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $169.82 / $588.84
| Professional | | $26.92 | $169.82 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $29.51 / $46.77
| Professional | 26 | $19.50 | $29.51 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $112.20 / $162.18 / $239.88
| Professional | TC | $112.20 | $162.18 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $131.83 / $204.17
| Facility | | $19.95 | $131.83 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $199.53 / $331.13
| Professional | | $131.83 | $199.53 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $26.92 / $50.12
| Professional | 26 | $17.38 | $26.92 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $112.20 / $169.82 / $275.42
| Professional | TC | $112.20 | $169.82 | $275.42 |