- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $724.44 / $1,202.26
| Facility | | $125.89 | $724.44 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $32.36 / $70.79
| Facility | 26 | $22.91 | $32.36 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $102.33 / $181.97 / $794.33
| Facility | TC | $102.33 | $181.97 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $134.90 / $346.74
| Professional | | $22.91 | $134.90 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $29.51 / $72.44
| Professional | 26 | $19.50 | $29.51 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $91.20 / $128.82 / $275.42
| Professional | TC | $91.20 | $128.82 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $123.03 / $281.84
| Professional | | $93.33 | $123.03 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $23.44 / $66.07
| Professional | 26 | $16.22 | $23.44 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $131.83 / $190.55
| Professional | | $117.49 | $131.83 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $22.91 / $33.11
| Professional | 26 | $20.42 | $22.91 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $107.15 / $154.88
| Professional | TC | $95.50 | $107.15 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $645.65 / $831.76
| Facility | | $316.23 | $645.65 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $194.98 / $331.13
| Professional | | $131.83 | $194.98 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $32.36 / $54.95
| Professional | 26 | $22.39 | $32.36 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $107.15 / $162.18 / $275.42
| Professional | TC | $107.15 | $162.18 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $208.93 / $323.59
| Professional | | $138.04 | $208.93 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $36.31 / $54.95
| Professional | 26 | $23.99 | $36.31 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $112.20 / $173.78 / $263.03
| Professional | TC | $112.20 | $173.78 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $213.80 / $416.87
| Professional | | $134.90 | $213.80 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $37.15 / $74.13
| Professional | 26 | $23.44 | $37.15 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $104.71 / $177.83 / $331.13
| Professional | TC | $104.71 | $177.83 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $85.11 / $93.33
| Facility | | $83.18 | $85.11 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $67.61 / $74.13
| Facility | 26 | $14.45 | $67.61 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $18.62 / $87.10
| Facility | TC | $16.98 | $18.62 | $87.10 |