- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $109.65 / $588.84
| Facility | | $38.02 | $109.65 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $27.54 / $69.18
| Facility | 26 | $8.91 | $27.54 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $83.18 / $204.17
| Facility | TC | $67.61 | $83.18 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $58.88 / $131.83
| Professional | | $32.36 | $58.88 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $17.78 / $34.67
| Professional | 26 | $10.00 | $17.78 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $43.65 / $95.50
| Professional | TC | $22.91 | $43.65 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $40.74 / $144.54
| Professional | | $11.48 | $40.74 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $10.23 / $12.59
| Professional | 26 | $10.23 | $10.23 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $33.88 / $33.88
| Professional | TC | $30.20 | $33.88 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $199.53 / $239.88
| Facility | | $134.90 | $199.53 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $44.67 / $97.72
| Professional | | $31.62 | $44.67 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $12.88 / $26.92
| Professional | 26 | $9.12 | $12.88 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $30.90 / $72.44
| Professional | TC | $23.44 | $30.90 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $46.77 / $95.50
| Professional | | $39.81 | $46.77 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $11.22 / $23.99
| Professional | 26 | $9.55 | $11.22 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $34.67 / $70.79
| Professional | TC | $29.51 | $34.67 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $501.19 / $588.84
| Facility | | $173.78 | $501.19 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $95.50 / $229.09
| Professional | | $36.31 | $95.50 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $70.79 / $95.50
| Professional | 26 | $10.47 | $70.79 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $89.13 / $154.88
| Professional | TC | $25.12 | $89.13 | $154.88 |