- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $251.19 / $524.81
| Facility | | $54.95 | $251.19 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $13.18 / $18.20
| Facility | 26 | $10.00 | $13.18 | $18.20 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $38.02 / $93.33
| Facility | TC | $25.70 | $38.02 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $54.95 / $120.23
| Professional | | $33.11 | $54.95 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $16.22 / $36.31
| Professional | 26 | $8.91 | $16.22 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $38.02 / $64.57
| Professional | TC | $22.91 | $38.02 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $31.62 / $54.95
| Professional | | $25.70 | $31.62 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $12.59 / $19.05
| Professional | 26 | $8.13 | $12.59 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $27.54 / $40.74
| Professional | TC | $19.50 | $27.54 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $199.53 / $354.81
| Facility | | $34.67 | $199.53 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $50.12 / $74.13
| Professional | | $32.36 | $50.12 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $14.45 / $22.39
| Professional | 26 | $11.22 | $14.45 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $30.90 / $54.95
| Professional | TC | $19.95 | $30.90 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $33.11 / $50.12
| Facility | | $11.22 | $33.11 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $32.36 / $48.98
| Professional | | $11.48 | $32.36 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $199.53 / $199.53
| Facility | | $87.10 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $46.77 / $85.11
| Professional | | $31.62 | $46.77 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $14.45 / $23.44
| Professional | 26 | $9.12 | $14.45 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $32.36 / $61.66
| Professional | TC | $22.91 | $32.36 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $74.13 / $74.13
| Facility | | $14.13 | $74.13 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $39.81 / $79.43
| Professional | | $31.62 | $39.81 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $12.30 / $30.20
| Professional | 26 | $10.00 | $12.30 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $27.54 / $52.48
| Professional | TC | $21.88 | $27.54 | $52.48 |