- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $446.68 / $501.19
| Facility | | $18.20 | $446.68 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $32.36 / $70.79
| Professional | | $21.88 | $32.36 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $16.60 / $75.86
| Professional | 26 | $8.91 | $16.60 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $23.99 / $41.69
| Professional | TC | $15.85 | $23.99 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $398.11 / $676.08
| Facility | | $181.97 | $398.11 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $64.57
| Facility | 26 | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $158.49
| Professional | | $46.77 | $46.77 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $14.13 / $44.67
| Professional | 26 | $14.13 | $14.13 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $37.15
| Professional | TC | $31.62 | $31.62 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $407.38 / $407.38
| Facility | | $218.78 | $407.38 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $47.86 / $112.20
| Professional | | $41.69 | $47.86 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $15.49 / $33.88
| Professional | 26 | $13.18 | $15.49 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $31.62 / $70.79
| Professional | TC | $26.30 | $31.62 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $33.88 / $33.88
| Professional | | $33.88 | $33.88 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $11.22 / $11.22
| Professional | 26 | $11.22 | $11.22 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $22.39 / $22.39
| Professional | TC | $22.39 | $22.39 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $45.71 / $125.89
| Professional | | $36.31 | $45.71 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $14.45 / $27.54
| Professional | 26 | $10.96 | $14.45 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $32.36 / $67.61
| Professional | TC | $24.55 | $32.36 | $67.61 |