- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $912.01 / $933.25
| Facility | | $478.63 | $912.01 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $239.88 / $446.68
| Professional | | $165.96 | $239.88 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $47.86 / $104.71
| Professional | 26 | $33.88 | $47.86 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $134.90 / $177.83 / $316.23
| Professional | TC | $134.90 | $177.83 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $66,069.34 / $95,499.26
| Facility | | $588.84 | $66,069.34 | $95,499.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $281.84
| Professional | | $58.88 | $58.88 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $309.03 / $870.96
| Facility | | $229.09 | $309.03 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $70.79
| Facility | 26 | $58.88 | $58.88 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $281.84 / $501.19
| Professional | | $154.88 | $281.84 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $52.48 / $89.13
| Professional | 26 | $32.36 | $52.48 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $223.87 / $398.11
| Professional | TC | $123.03 | $223.87 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $316.23 / $524.81
| Facility | | $309.03 | $316.23 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $316.23 / $524.81
| Professional | | $309.03 | $316.23 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $281.84 / $436.52
| Facility | | $181.97 | $281.84 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $70.79
| Facility | 26 | $58.88 | $58.88 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $323.59 / $489.78
| Professional | | $229.09 | $323.59 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $56.23 / $74.13
| Professional | 26 | $36.31 | $56.23 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $218.78 / $323.59
| Professional | TC | $151.36 | $218.78 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $177.83 / $177.83
| Facility | | $177.83 | $177.83 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $316.23 / $416.87
| Professional | | $239.88 | $316.23 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $64.57 / $87.10
| Professional | 26 | $44.67 | $64.57 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $245.47 / $338.84
| Professional | TC | $194.98 | $245.47 | $338.84 |