- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $389.05 / $616.60
| Facility | | $51.29 | $389.05 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $9.55 / $9.55
| Facility | 26 | $8.32 | $9.55 | $9.55 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $331.13 / $426.58
| Facility | TC | $223.87 | $331.13 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $37.15 / $83.18
| Professional | | $7.94 | $37.15 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $13.80 / $38.90
| Professional | 26 | $7.94 | $13.80 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $42.66 / $91.20
| Professional | TC | $25.12 | $42.66 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $128.82 / $128.82
| Professional | | $83.18 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $33.11 / $33.11
| Professional | 26 | $20.89 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $97.72 / $97.72
| Professional | TC | $63.10 | $97.72 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $54.95 / $93.33
| Professional | | $33.88 | $54.95 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $16.60 / $26.30
| Professional | 26 | $9.12 | $16.60 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $39.81 / $70.79
| Professional | TC | $24.55 | $39.81 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $13.49 / $79.43
| Facility | | $5.62 | $13.49 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $53.70 / $102.33
| Professional | | $34.67 | $53.70 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $15.14 / $26.92
| Professional | 26 | $8.51 | $15.14 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $38.02 / $74.13
| Professional | TC | $25.70 | $38.02 | $74.13 |