- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $239.88 / $436.52
| Facility | | $47.86 | $239.88 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $61.66 / $66.07
| Facility | 26 | $12.88 | $61.66 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $363.08 / $436.52
| Facility | TC | $199.53 | $363.08 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $47.86 / $169.82
| Professional | | $35.48 | $47.86 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $16.22 / $38.02
| Professional | 26 | $10.00 | $16.22 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $38.02 / $114.82
| Professional | TC | $25.12 | $38.02 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $112.20 / $724.44
| Facility | | $39.81 | $112.20 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $47.86 / $83.18
| Professional | | $36.31 | $47.86 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $15.14 / $23.44
| Professional | 26 | $10.96 | $15.14 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $33.11 / $56.23
| Professional | TC | $24.55 | $33.11 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $33.11 / $60.26
| Professional | | $19.05 | $33.11 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $181.97 / $302.00
| Facility | | $125.89 | $181.97 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $147.91
| Facility | 26 | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $147.91
| Facility | TC | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $66.07 / $77.62
| Professional | | $54.95 | $66.07 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $17.78 / $26.92
| Professional | 26 | $14.79 | $17.78 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $45.71 / $53.70
| Professional | TC | $40.74 | $45.71 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $60.26 / $79.43
| Professional | | $38.02 | $60.26 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $16.98 / $25.70
| Professional | 26 | $10.23 | $16.98 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $43.65 / $51.29
| Professional | TC | $27.54 | $43.65 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $40.74 / $72.44
| Professional | | $15.14 | $40.74 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $38.90 / $67.61
| Professional | | $33.11 | $38.90 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $11.48 / $19.50
| Professional | 26 | $9.55 | $11.48 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $26.92 / $47.86
| Professional | TC | $21.88 | $26.92 | $47.86 |