- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $208.93 / $501.19
| Facility | | $43.65 | $208.93 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $10.47 / $24.55
| Facility | 26 | $6.92 | $10.47 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $72.44 / $354.81
| Facility | TC | $23.44 | $72.44 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $32.36 / $85.11
| Professional | | $11.22 | $32.36 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $11.48 / $34.67
| Professional | 26 | $7.08 | $11.48 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $26.92 / $58.88
| Professional | TC | $18.20 | $26.92 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $83.18 / $269.15
| Facility | | $25.70 | $83.18 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $8.91 / $8.91
| Facility | 26 | $8.91 | $8.91 | $8.91 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $21.38 / $21.38
| Facility | TC | $21.38 | $21.38 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $36.31 / $66.07
| Professional | | $26.92 | $36.31 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $10.96 / $19.05
| Professional | 26 | $6.76 | $10.96 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $26.30 / $50.12
| Professional | TC | $18.62 | $26.30 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $89.13 / $269.15
| Facility | | $45.71 | $89.13 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.86 / $10.00 / $26.92
| Facility | 26 | $1.86 | $10.00 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.62 / $30.20 / $91.20
| Facility | TC | $5.62 | $30.20 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $40.74 / $81.28
| Professional | | $24.55 | $40.74 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.61 / $11.22 / $21.38
| Professional | 26 | $6.61 | $11.22 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $30.20 / $63.10
| Professional | TC | $18.20 | $30.20 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $81.28 / $218.78
| Facility | | $20.42 | $81.28 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $38.02 / $100.00
| Professional | | $25.70 | $38.02 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $10.47 / $52.48
| Professional | 26 | $7.24 | $10.47 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $25.70 / $50.12
| Professional | TC | $18.20 | $25.70 | $50.12 |