- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $549.54 / $616.60
| Facility | | $398.11 | $549.54 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $39.81
| Facility | 26 | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $177.83 / $269.15
| Professional | | $144.54 | $177.83 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $48.98 / $85.11
| Professional | 26 | $37.15 | $48.98 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $104.71 / $117.49 / $177.83
| Professional | TC | $104.71 | $117.49 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $97.72 / $162.18
| Facility | | $41.69 | $97.72 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $91.20 / $234.42
| Professional | | $38.90 | $91.20 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $251.19 / $251.19
| Facility | | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $43.65 / $63.10
| Facility | 26 | $9.55 | $43.65 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $251.19 / $691.83
| Professional | | $123.03 | $251.19 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $79.43 / $177.83
| Professional | 26 | $38.02 | $79.43 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $173.78 / $416.87
| Professional | TC | $89.13 | $173.78 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $457.09 / $691.83
| Facility | | $165.96 | $457.09 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $79.43 / $79.43
| Professional | 26 | $51.29 | $79.43 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $208.93 / $331.13
| Professional | | $125.89 | $208.93 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $60.26 / $95.50
| Professional | 26 | $37.15 | $60.26 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $91.20 / $158.49 / $239.88
| Professional | TC | $91.20 | $158.49 | $239.88 |