- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $120.23 / $363.08
| Facility | | $42.66 | $120.23 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $13.80 / $17.78
| Facility | 26 | $12.02 | $13.80 | $17.78 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $42.66 / $257.04
| Facility | TC | $28.18 | $42.66 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $46.77 / $100.00
| Professional | | $30.90 | $46.77 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $13.80 / $33.11
| Professional | 26 | $8.91 | $13.80 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $30.20 / $57.54
| Professional | TC | $21.88 | $30.20 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $32.36 / $48.98
| Professional | | $26.30 | $32.36 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $9.77 / $15.14
| Professional | 26 | $7.08 | $9.77 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $26.30 / $34.67
| Professional | TC | $19.50 | $26.30 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $95.50 / $181.97
| Facility | | $53.70 | $95.50 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $47.86 / $57.54
| Professional | | $40.74 | $47.86 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $14.45 / $19.05
| Professional | 26 | $11.75 | $14.45 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $34.67 / $38.90
| Professional | TC | $29.51 | $34.67 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $39.81 / $83.18
| Facility | | $36.31 | $39.81 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $27.54 / $39.81
| Facility | TC | $26.30 | $27.54 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $19.05 / $19.05
| Professional | 26 | $10.00 | $19.05 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $75.86 / $107.15
| Facility | | $51.29 | $75.86 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $36.31 / $70.79
| Professional | | $23.44 | $36.31 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $12.30 / $21.88
| Professional | 26 | $7.24 | $12.30 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $26.30 / $47.86
| Professional | TC | $16.60 | $26.30 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $131.83 / $218.78
| Facility | | $44.67 | $131.83 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $38.02 / $57.54
| Professional | | $26.92 | $38.02 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $11.48 / $17.38
| Professional | 26 | $8.91 | $11.48 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $26.30 / $40.74
| Professional | TC | $17.38 | $26.30 | $40.74 |