- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $95.50 / $190.55
| Facility | | $81.28 | $95.50 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $22.39 / $56.23
| Facility | 26 | $7.08 | $22.39 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $77.62 / $190.55
| Facility | TC | $25.70 | $77.62 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $37.15 / $97.72
| Professional | | $28.18 | $37.15 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $18.62 / $38.90
| Professional | 26 | $7.08 | $18.62 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $25.70 / $50.12
| Professional | TC | $18.20 | $25.70 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $40.74 / $141.25
| Professional | | $37.15 | $40.74 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $9.33 / $13.49
| Professional | 26 | $8.32 | $9.33 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $38.02
| Professional | TC | $28.18 | $28.18 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $223.87 / $223.87
| Facility | | $128.82 | $223.87 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $43.65 / $93.33
| Professional | | $30.20 | $43.65 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $13.49 / $27.54
| Professional | 26 | $7.41 | $13.49 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $28.84 / $67.61
| Professional | TC | $21.88 | $28.84 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $41.69 / $85.11
| Professional | | $35.48 | $41.69 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $9.55 / $25.12
| Professional | 26 | $7.94 | $9.55 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $31.62 / $66.07
| Professional | TC | $26.92 | $31.62 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $501.19 / $588.84
| Facility | | $173.78 | $501.19 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $95.50 / $234.42
| Professional | | $33.88 | $95.50 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $75.86 / $95.50
| Professional | 26 | $9.33 | $75.86 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $37.15 / $125.89
| Professional | TC | $21.38 | $37.15 | $125.89 |