- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $194.98 / $389.05
| Facility | | $85.11 | $194.98 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $66.07 / $69.18
| Facility | 26 | $12.02 | $66.07 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $316.23 / $398.11
| Facility | TC | $154.88 | $316.23 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $41.69 / $138.04
| Professional | | $27.54 | $41.69 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $14.13 / $44.67
| Professional | 26 | $8.51 | $14.13 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $26.92 / $56.23
| Professional | TC | $17.78 | $26.92 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $158.49 / $354.81
| Facility | | $31.62 | $158.49 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $41.69 / $69.18
| Professional | | $31.62 | $41.69 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $14.79 / $22.91
| Professional | 26 | $10.96 | $14.79 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $25.70 / $44.67
| Professional | TC | $19.95 | $25.70 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $33.11 / $60.26
| Professional | | $23.99 | $33.11 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $208.93 / $302.00
| Facility | | $144.54 | $208.93 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $147.91
| Facility | 26 | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $147.91
| Facility | TC | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $56.23 / $64.57
| Professional | | $46.77 | $56.23 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $16.98 / $22.39
| Professional | 26 | $14.45 | $16.98 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $37.15 / $42.66
| Professional | TC | $32.36 | $37.15 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $51.29 / $67.61
| Professional | | $31.62 | $51.29 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $16.60 / $22.91
| Professional | 26 | $9.77 | $16.60 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $31.62 / $41.69
| Professional | TC | $21.88 | $31.62 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $32.36 / $54.95
| Professional | | $14.79 | $32.36 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $33.11 / $56.23
| Professional | | $28.84 | $33.11 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $11.22 / $18.62
| Professional | 26 | $10.00 | $11.22 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $21.88 / $38.02
| Professional | TC | $18.62 | $21.88 | $38.02 |