- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $295.12 / $389.05
| Facility | | $52.48 | $295.12 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $8.32 / $13.49
| Facility | 26 | $7.08 | $8.32 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $316.23 / $389.05
| Facility | TC | $218.78 | $316.23 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $28.84 / $63.10
| Professional | | $14.79 | $28.84 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $13.49 / $30.20
| Professional | 26 | $7.08 | $13.49 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $25.70 / $47.86
| Professional | TC | $19.05 | $25.70 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $28.84 / $47.86
| Facility | | $9.33 | $28.84 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $33.11 / $66.07
| Professional | | $10.00 | $33.11 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $77.62 / $181.97
| Facility | | $50.12 | $77.62 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.86 / $8.71 / $12.59
| Facility | 26 | $1.86 | $8.71 | $12.59 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.62 / $26.30 / $38.02
| Facility | TC | $5.62 | $26.30 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $41.69 / $151.36
| Professional | | $24.55 | $41.69 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $11.22 / $41.69
| Professional | 26 | $6.17 | $11.22 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $30.90 / $114.82
| Professional | TC | $18.62 | $30.90 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $295.12 / $562.34
| Facility | | $114.82 | $295.12 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $269.15 / $407.38
| Facility | TC | $93.33 | $269.15 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $83.18 / $85.11
| Professional | | $48.98 | $83.18 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $13.18 / $20.42
| Professional | 26 | $9.77 | $13.18 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $245.47
| Facility | | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $34.67 / $60.26
| Professional | | $21.88 | $34.67 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $10.00 / $19.50
| Professional | 26 | $6.17 | $10.00 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $23.44 / $42.66
| Professional | TC | $15.85 | $23.44 | $42.66 |