- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $91.20 / $389.05
| Facility | | $43.65 | $91.20 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $11.75 / $26.92
| Facility | 26 | $10.47 | $11.75 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $46.77 / $398.11
| Facility | TC | $28.18 | $46.77 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $47.86 / $97.72
| Professional | | $32.36 | $47.86 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $15.85 / $50.12
| Professional | 26 | $8.91 | $15.85 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $32.36 / $70.79
| Professional | TC | $21.88 | $32.36 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $138.04
| Facility | | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $40.74 / $67.61
| Professional | | $28.84 | $40.74 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $12.30 / $21.88
| Professional | 26 | $7.59 | $12.30 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $28.84 / $47.86
| Professional | TC | $19.50 | $28.84 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $181.97 / $229.09
| Facility | | $56.23 | $181.97 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $177.83 / $177.83 / $363.08
| Facility | TC | $177.83 | $177.83 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $37.15 / $42.66
| Professional | | $36.31 | $37.15 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $13.49 / $112.20
| Professional | 26 | $9.77 | $13.49 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $51.29 / $199.53
| Professional | | $31.62 | $51.29 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $15.14 / $79.43
| Professional | 26 | $8.51 | $15.14 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $35.48 / $144.54
| Professional | TC | $22.91 | $35.48 | $144.54 |