- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $229.09 / $389.05
| Facility | | $43.65 | $229.09 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $10.00 / $14.45
| Facility | 26 | $7.41 | $10.00 | $14.45 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $30.90 / $74.13
| Facility | TC | $21.38 | $30.90 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $30.20 / $74.13
| Professional | | $10.96 | $30.20 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $12.02 / $30.20
| Professional | 26 | $7.08 | $12.02 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $26.92 / $51.29
| Professional | TC | $19.05 | $26.92 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $28.18 / $56.23
| Professional | | $19.50 | $28.18 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $9.55 / $14.79
| Professional | 26 | $6.17 | $9.55 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $30.90 / $42.66
| Professional | TC | $21.88 | $30.90 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $199.53 / $354.81
| Facility | | $30.90 | $199.53 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $30.90 / $52.48
| Professional | | $28.18 | $30.90 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $11.48 / $17.78
| Professional | 26 | $8.71 | $11.48 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $19.50 / $37.15
| Professional | TC | $18.62 | $19.50 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $26.92 / $39.81
| Facility | | $8.13 | $26.92 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $26.92 / $38.90
| Professional | | $8.13 | $26.92 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $60.26 / $199.53
| Facility | | $29.51 | $60.26 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $38.90 / $67.61
| Professional | | $25.70 | $38.90 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $10.72 / $18.62
| Professional | 26 | $6.76 | $10.72 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $27.54 / $51.29
| Professional | TC | $19.50 | $27.54 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $74.13 / $74.13
| Facility | | $11.22 | $74.13 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $31.62 / $58.88
| Professional | | $26.30 | $31.62 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $9.12 / $18.62
| Professional | 26 | $7.59 | $9.12 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $22.91 / $39.81
| Professional | TC | $18.62 | $22.91 | $39.81 |