- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $151.36 / $295.12
| Facility | | $53.70 | $151.36 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $10.00 / $26.92
| Facility | 26 | $9.33 | $10.00 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $54.95 / $331.13
| Facility | TC | $22.39 | $54.95 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $52.48 / $81.28
| Professional | | $31.62 | $52.48 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $14.13 / $26.92
| Professional | 26 | $8.91 | $14.13 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $33.11 / $57.54
| Professional | TC | $22.91 | $33.11 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $29.51 / $41.69
| Professional | | $25.12 | $29.51 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $10.72 / $24.55
| Professional | 26 | $7.76 | $10.72 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $25.12 / $32.36
| Professional | TC | $19.95 | $25.12 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $173.78
| Facility | | $158.49 | $158.49 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $51.29
| Professional | | $51.29 | $51.29 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $64.57 / $79.43
| Facility | | $30.20 | $64.57 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $46.77 / $67.61
| Professional | | $27.54 | $46.77 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $15.49 / $22.39
| Professional | 26 | $9.12 | $15.49 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $31.62 / $44.67
| Professional | TC | $18.20 | $31.62 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $32.36 / $33.11
| Professional | | $21.38 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $158.49 / $173.78
| Facility | | $61.66 | $158.49 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $38.90 / $66.07
| Professional | | $26.30 | $38.90 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $12.02 / $22.91
| Professional | 26 | $9.12 | $12.02 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $26.30 / $45.71
| Professional | TC | $18.20 | $26.30 | $45.71 |