- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $758.58 / $1,174.90
| Facility | | $97.72 | $758.58 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $24.55 / $31.62
| Facility | 26 | $21.88 | $24.55 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $123.03 / $933.25
| Facility | TC | $97.72 | $123.03 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $128.82 / $707.95
| Professional | | $29.51 | $128.82 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $28.18 / $95.50
| Professional | 26 | $19.50 | $28.18 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $109.65 / $186.21
| Professional | TC | $89.13 | $109.65 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $107.15 / $223.87
| Professional | | $85.11 | $107.15 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $19.95 / $38.02
| Professional | 26 | $15.85 | $19.95 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $89.13
| Professional | TC | $89.13 | $89.13 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $309.03 / $630.96
| Facility | | $158.49 | $309.03 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $251.19 / $912.01
| Facility | TC | $165.96 | $251.19 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $158.49 / $257.04
| Professional | | $112.20 | $158.49 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $32.36 / $43.65
| Professional | 26 | $20.89 | $32.36 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $91.20 / $125.89 / $194.98
| Professional | TC | $91.20 | $125.89 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $457.09 / $588.84
| Facility | | $309.03 | $457.09 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $169.82 / $251.19
| Professional | | $117.49 | $169.82 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $28.84 / $42.66
| Professional | 26 | $21.88 | $28.84 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $144.54 / $208.93
| Professional | TC | $95.50 | $144.54 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $158.49 / $275.42
| Facility | | $117.49 | $158.49 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $436.52 / $691.83
| Facility | | $22.91 | $436.52 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $147.91 / $251.19
| Professional | | $107.15 | $147.91 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $22.91 / $39.81
| Professional | 26 | $19.50 | $22.91 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $123.03 / $208.93
| Professional | TC | $87.10 | $123.03 | $208.93 |