- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $562.34 / $870.96
| Facility | | $208.93 | $562.34 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $33.11 / $58.88
| Facility | 26 | $26.30 | $33.11 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $331.13 / $512.86
| Facility | TC | $61.66 | $331.13 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $32.36 / $91.20
| Professional | | $18.20 | $32.36 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $10.23 / $29.51
| Professional | 26 | $6.03 | $10.23 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.88 / $28.84 / $66.07
| Professional | TC | $12.88 | $28.84 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $389.05
| Facility | | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $44.67 / $87.10
| Professional | | $30.90 | $44.67 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $12.88 / $26.92
| Professional | 26 | $8.71 | $12.88 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $30.20 / $58.88
| Professional | TC | $22.39 | $30.20 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $60.26 / $660.69
| Facility | | $26.30 | $60.26 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $33.11 / $58.88
| Facility | 26 | $24.55 | $33.11 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $331.13 / $660.69
| Facility | TC | $60.26 | $331.13 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $72.44 / $120.23
| Professional | | $23.99 | $72.44 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $22.39 / $56.23
| Professional | 26 | $7.94 | $22.39 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $53.70 / $97.72
| Professional | TC | $22.91 | $53.70 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $117.49 / $169.82
| Professional | | $109.65 | $117.49 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $30.90 / $53.70
| Professional | 26 | $28.84 | $30.90 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $87.10 / $123.03
| Professional | TC | $63.10 | $87.10 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $40.74 / $67.61
| Facility | | $23.99 | $40.74 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $72.44 / $87.10
| Professional | | $32.36 | $72.44 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.46 / $11.48 / $29.51
| Professional | 26 | $6.46 | $11.48 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $26.30 / $58.88
| Professional | TC | $18.20 | $26.30 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $69.18 / $154.88
| Professional | | $33.88 | $69.18 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $23.44 / $58.88
| Professional | 26 | $9.12 | $23.44 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $45.71 / $97.72
| Professional | TC | $25.70 | $45.71 | $97.72 |