- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $181.97 / $316.23
| Facility | | $37.15 | $181.97 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $8.51 / $44.67
| Facility | 26 | $7.24 | $8.51 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $28.18 / $102.33
| Facility | TC | $18.62 | $28.18 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $43.65 / $87.10
| Professional | | $25.70 | $43.65 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $10.96 / $25.70
| Professional | 26 | $7.08 | $10.96 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $25.70 / $50.12
| Professional | TC | $18.62 | $25.70 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $30.20 / $53.70
| Professional | | $22.39 | $30.20 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.31 / $8.91 / $19.95
| Professional | 26 | $6.31 | $8.91 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.45 / $21.88 / $30.20
| Professional | TC | $14.45 | $21.88 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $30.90 / $63.10
| Professional | | $18.62 | $30.90 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $13.18 / $20.89
| Professional | 26 | $8.32 | $13.18 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $29.51 / $53.70
| Professional | TC | $18.62 | $29.51 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $56.23 / $104.71
| Facility | | $43.65 | $56.23 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $10.23 / $10.23
| Facility | 26 | $10.23 | $10.23 | $10.23 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $23.44 / $23.44
| Facility | TC | $23.44 | $23.44 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $36.31 / $63.10
| Professional | | $25.70 | $36.31 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $11.22 / $19.50
| Professional | 26 | $7.24 | $11.22 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $25.70 / $46.77
| Professional | TC | $17.78 | $25.70 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $363.08
| Facility | | $208.93 | $208.93 | $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
- $154.88 / $154.88 / $154.88
| Facility | TC | $154.88 | $154.88 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $275.42 / $275.42
| Professional | | $208.93 | $275.42 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $85.11
| Professional | 26 | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $177.83 / $208.93 / $208.93
| Professional | TC | $177.83 | $208.93 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $38.02 / $95.50
| Facility | | $10.72 | $38.02 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $33.88 / $58.88
| Professional | | $26.92 | $33.88 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $10.00 / $17.38
| Professional | 26 | $8.13 | $10.00 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $23.44 / $41.69
| Professional | TC | $18.62 | $23.44 | $41.69 |