- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $117.49 / $562.34
| Facility | | $39.81 | $117.49 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $38.02 / $83.18
| Facility | 26 | $12.30 | $38.02 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $74.13 / $190.55
| Facility | TC | $41.69 | $74.13 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $53.70 / $151.36
| Professional | | $32.36 | $53.70 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $15.49 / $43.65
| Professional | 26 | $9.77 | $15.49 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $36.31 / $89.13
| Professional | TC | $22.91 | $36.31 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $29.51 / $44.67
| Professional | | $25.12 | $29.51 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $8.32 / $10.47
| Professional | 26 | $6.76 | $8.32 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $22.39 / $30.90
| Professional | TC | $19.05 | $22.39 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $85.11 / $162.18
| Facility | | $21.88 | $85.11 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $40.74 / $165.96
| Professional | | $34.67 | $40.74 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $10.72 / $16.98
| Professional | 26 | $8.51 | $10.72 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $30.90 / $125.89
| Professional | TC | $26.30 | $30.90 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $134.90 / $331.13
| Facility | | $83.18 | $134.90 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.63 / $12.30 / $17.38
| Facility | 26 | $2.63 | $12.30 | $17.38 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.76 / $31.62 / $44.67
| Facility | TC | $6.76 | $31.62 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $44.67 / $81.28
| Professional | | $31.62 | $44.67 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $12.59 / $23.44
| Professional | 26 | $8.91 | $12.59 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $30.90 / $57.54
| Professional | TC | $21.88 | $30.90 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $46.77 / $117.49
| Facility | | $34.67 | $46.77 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $100.00 / $100.00
| Facility | 26 | $25.12 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $131.83 / $131.83
| Facility | TC | $61.66 | $131.83 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $43.65 / $257.04
| Professional | | $35.48 | $43.65 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $12.30 / $83.18
| Professional | 26 | $10.23 | $12.30 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $29.51 / $208.93
| Professional | TC | $23.44 | $29.51 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $89.13 / $134.90
| Facility | | $18.62 | $89.13 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $38.90 / $95.50
| Professional | | $35.48 | $38.90 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $11.75 / $70.79
| Professional | 26 | $10.23 | $11.75 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $28.18 / $85.11
| Professional | TC | $23.44 | $28.18 | $85.11 |