- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $57.54 / $57.54
| Facility | | $57.54 | $57.54 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $16.98 / $16.98
| Facility | 26 | $16.98 | $16.98 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $67.61 / $144.54
| Professional | | $57.54 | $67.61 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $16.98 / $25.12
| Professional | 26 | $14.13 | $16.98 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $48.98 / $114.82
| Professional | TC | $39.81 | $48.98 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $218.78 / $309.03
| Facility | | $158.49 | $218.78 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $61.66 / $85.11
| Professional | | $18.20 | $61.66 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $1,122.02
| Facility | | $169.82 | $169.82 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $107.15 / $186.21
| Professional | | $64.57 | $107.15 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $23.99 / $30.20
| Professional | 26 | $17.78 | $23.99 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $91.20 / $158.49
| Professional | TC | $52.48 | $91.20 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $79.43 / $229.09
| Facility | | $53.70 | $79.43 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $134.90 / $134.90
| Facility | 26 | $41.69 | $134.90 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $102.33 / $812.83
| Professional | | $57.54 | $102.33 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $21.38 / $416.87
| Professional | 26 | $15.85 | $21.38 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $93.33 / $562.34
| Professional | TC | $41.69 | $93.33 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $338.84 / $562.34
| Facility | | $18.62 | $338.84 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $89.13 / $144.54
| Professional | | $53.70 | $89.13 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $19.05 / $28.84
| Professional | 26 | $15.14 | $19.05 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $63.10 / $117.49
| Professional | TC | $38.90 | $63.10 | $117.49 |