- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $758.58 / $1,995.26
| Facility | | $208.93 | $758.58 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $39.81 / $56.23
| Facility | 26 | $32.36 | $39.81 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $223.87 / $912.01
| Facility | TC | $151.36 | $223.87 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $275.42 / $758.58
| Professional | | $169.82 | $275.42 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $45.71 / $125.89
| Professional | 26 | $30.20 | $45.71 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $186.21 / $407.38
| Professional | TC | $141.25 | $186.21 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $138.04 / $281.84
| Professional | | $120.23 | $138.04 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $25.70 / $47.86
| Professional | 26 | $24.55 | $25.70 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $112.20 / $112.20 / $117.49
| Professional | TC | $112.20 | $112.20 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $1,479.11 / $1,479.11
| Facility | | $1,479.11 | $1,479.11 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $223.87 / $354.81
| Professional | | $186.21 | $223.87 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $43.65 / $67.61
| Professional | 26 | $34.67 | $43.65 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $181.97 / $281.84
| Professional | TC | $147.91 | $181.97 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $208.93 / $269.15
| Professional | | $177.83 | $208.93 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $38.90 / $51.29
| Professional | 26 | $33.11 | $38.90 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $169.82 / $223.87
| Professional | TC | $151.36 | $169.82 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $588.84 / $912.01
| Facility | | $346.74 | $588.84 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $37.15 / $52.48
| Facility | 26 | $7.94 | $37.15 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $165.96 / $234.42
| Facility | TC | $35.48 | $165.96 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $269.15 / $512.86
| Professional | | $177.83 | $269.15 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $47.86 / $93.33
| Professional | 26 | $32.36 | $47.86 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $234.42 / $436.52
| Professional | TC | $147.91 | $234.42 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $275.42 / $660.69
| Facility | | $181.97 | $275.42 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $213.80 / $213.80
| Facility | 26 | $75.86 | $213.80 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $309.03 / $691.83 / $691.83
| Facility | TC | $309.03 | $691.83 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $288.40 / $1,584.89
| Professional | | $186.21 | $288.40 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $48.98 / $891.25
| Professional | 26 | $33.11 | $48.98 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $234.42 / $1,380.38
| Professional | TC | $151.36 | $234.42 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $199.53 / $794.33
| Facility | | $46.77 | $199.53 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $239.88 / $407.38
| Professional | | $181.97 | $239.88 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $42.66 / $87.10
| Professional | 26 | $32.36 | $42.66 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $194.98 / $302.00
| Professional | TC | $147.91 | $194.98 | $302.00 |