- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $141.25 / $354.81
| Facility | | $38.90 | $141.25 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $14.45 / $17.38
| Facility | 26 | $11.75 | $14.45 | $17.38 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $43.65 / $194.98
| Facility | TC | $25.12 | $43.65 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $51.29 / $114.82
| Professional | | $32.36 | $51.29 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $14.79 / $34.67
| Professional | 26 | $8.91 | $14.79 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $32.36 / $60.26
| Professional | TC | $21.88 | $32.36 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $31.62 / $60.26
| Professional | | $25.70 | $31.62 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $8.71 / $16.98
| Professional | 26 | $6.76 | $8.71 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $23.44 / $37.15
| Professional | TC | $22.91 | $23.44 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $104.71
| Facility | | $75.86 | $75.86 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $42.66 / $54.95
| Professional | | $37.15 | $42.66 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $14.13 / $18.20
| Professional | 26 | $12.30 | $14.13 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $28.84 / $36.31
| Professional | TC | $25.12 | $28.84 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $35.48 / $61.66
| Facility | | $13.49 | $35.48 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $33.88 / $58.88
| Professional | | $11.75 | $33.88 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $54.95 / $162.18
| Facility | | $38.02 | $54.95 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.63 / $12.30 / $17.38
| Facility | 26 | $2.63 | $12.30 | $17.38 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.76 / $31.62 / $44.67
| Facility | TC | $6.76 | $31.62 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $45.71 / $72.44
| Professional | | $31.62 | $45.71 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $14.13 / $21.88
| Professional | 26 | $9.55 | $14.13 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $30.20 / $48.98
| Professional | TC | $21.38 | $30.20 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $67.61 / $77.62
| Professional | | $47.86 | $67.61 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $19.50 / $22.39
| Professional | 26 | $8.91 | $19.50 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $40.74 / $56.23
| Professional | TC | $25.12 | $40.74 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $141.25 / $251.19
| Facility | | $100.00 | $141.25 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $39.81 / $77.62
| Professional | | $33.11 | $39.81 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $13.18 / $22.91
| Professional | 26 | $10.00 | $13.18 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $27.54 / $53.70
| Professional | TC | $22.91 | $27.54 | $53.70 |