- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $169.82 / $323.59
| Facility | | $56.23 | $169.82 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $12.88 / $57.54
| Facility | 26 | $9.33 | $12.88 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $60.26 / $251.19
| Facility | TC | $22.39 | $60.26 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $50.12 / $107.15
| Professional | | $30.90 | $50.12 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $14.45 / $30.90
| Professional | 26 | $8.91 | $14.45 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $32.36 / $61.66
| Professional | TC | $22.39 | $32.36 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $35.48 / $64.57
| Professional | | $25.12 | $35.48 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $10.00 / $21.88
| Professional | 26 | $7.94 | $10.00 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $28.18 / $39.81
| Professional | TC | $18.20 | $28.18 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $37.15 / $77.62
| Professional | | $21.88 | $37.15 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $17.38 / $27.54
| Professional | 26 | $10.72 | $17.38 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $35.48 / $64.57
| Professional | TC | $21.88 | $35.48 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $69.18 / $117.49
| Facility | | $52.48 | $69.18 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $13.18 / $13.18
| Facility | 26 | $13.18 | $13.18 | $13.18 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $27.54
| Facility | TC | $27.54 | $27.54 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $42.66 / $75.86
| Professional | | $30.90 | $42.66 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $14.45 / $24.55
| Professional | 26 | $9.55 | $14.45 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $30.20 / $54.95
| Professional | TC | $20.89 | $30.20 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $257.04 / $363.08
| Facility | | $257.04 | $257.04 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | 26 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $186.21
| Facility | TC | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $331.13 / $331.13
| Professional | | $257.04 | $331.13 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $120.23 / $120.23
| Professional | 26 | $95.50 | $120.23 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $245.47 / $245.47
| Professional | TC | $194.98 | $245.47 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $50.12 / $95.50
| Facility | | $13.49 | $50.12 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $40.74 / $72.44
| Professional | | $33.11 | $40.74 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $12.88 / $22.91
| Professional | 26 | $10.72 | $12.88 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $26.92 / $50.12
| Professional | TC | $21.88 | $26.92 | $50.12 |