- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $489.78 / $691.83
| Facility | | $79.43 | $489.78 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $10.00 / $13.18
| Facility | 26 | $10.00 | $10.00 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $39.81 / $128.82
| Professional | | $23.44 | $39.81 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $12.59 / $57.54
| Professional | 26 | $8.91 | $12.59 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $25.70 / $58.88
| Professional | TC | $19.95 | $25.70 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $24.55 / $30.20
| Professional | | $22.39 | $24.55 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $7.94 / $8.32
| Professional | 26 | $7.94 | $7.94 | $8.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $46.77 / $46.77
| Facility | | $29.51 | $46.77 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $34.67 / $57.54
| Professional | | $33.11 | $34.67 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $10.23 / $17.38
| Professional | 26 | $9.77 | $10.23 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $24.55 / $40.74
| Professional | TC | $22.39 | $24.55 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $169.82 / $501.19
| Facility | | $58.88 | $169.82 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $41.69 / $64.57
| Professional | | $28.18 | $41.69 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $13.49 / $18.62
| Professional | 26 | $8.91 | $13.49 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $28.84 / $46.77
| Professional | TC | $19.05 | $28.84 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.32 / $43.65 / $57.54
| Professional | | $0.32 | $43.65 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.14 / $12.30 / $16.60
| Professional | 26 | $0.14 | $12.30 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $0.18 / $30.90 / $40.74
| Professional | TC | $0.18 | $30.90 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.32 / $0.32 / $53.70
| Professional | | $0.32 | $0.32 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.14 / $0.14 / $15.49
| Professional | 26 | $0.14 | $0.14 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $0.18 / $0.18 / $38.90
| Professional | TC | $0.18 | $0.18 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $36.31 / $38.02
| Professional | | $34.67 | $36.31 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $10.23 / $10.96
| Professional | 26 | $10.23 | $10.23 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $25.70 / $26.92
| Professional | TC | $23.99 | $25.70 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $38.02 / $181.97
| Facility | | $38.02 | $38.02 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $36.31 / $57.54
| Professional | | $26.92 | $36.31 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $11.48 / $19.05
| Professional | 26 | $7.76 | $11.48 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $24.55 / $43.65
| Professional | TC | $16.98 | $24.55 | $43.65 |