- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $891.25 / $1,479.11
| Facility | | $371.54 | $891.25 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $37.15 / $54.95
| Facility | 26 | $33.11 | $37.15 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $138.04 / $575.44 / $933.25
| Facility | TC | $138.04 | $575.44 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $281.84 / $776.25
| Professional | | $173.78 | $281.84 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $56.23 / $72.44
| Professional | 26 | $30.20 | $56.23 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $138.04 / $177.83 / $275.42
| Professional | TC | $138.04 | $177.83 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $162.18 / $245.47
| Facility | | $34.67 | $162.18 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $154.88 / $331.13
| Professional | | $33.11 | $154.88 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $489.78
| Facility | | $288.40 | $288.40 | $489.78 |
- 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
- $169.82 / $263.03 / $870.96
| Professional | | $169.82 | $263.03 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $45.71 / $165.96
| Professional | 26 | $30.90 | $45.71 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $138.04 / $213.80 / $724.44
| Professional | TC | $138.04 | $213.80 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $912.01 / $1,380.38
| Facility | | $446.68 | $912.01 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $588.84 / $912.01 / $1,148.15
| Facility | TC | $588.84 | $912.01 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $316.23 / $323.59
| Professional | | $316.23 | $316.23 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $53.70 / $87.10
| Professional | 26 | $50.12 | $53.70 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $257.04 / $281.84
| Professional | TC | $251.19 | $257.04 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $660.69 / $660.69
| Facility | | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $229.09 / $436.52
| Professional | | $158.49 | $229.09 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $38.02 / $79.43
| Professional | 26 | $29.51 | $38.02 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $194.98 / $380.19
| Professional | TC | $125.89 | $194.98 | $380.19 |