- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $199.53 / $371.54
| Facility | | $51.29 | $199.53 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $10.23 / $13.49
| Facility | 26 | $8.13 | $10.23 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $28.18 / $229.09
| Facility | TC | $18.62 | $28.18 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $39.81 / $112.20
| Professional | | $25.12 | $39.81 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $11.22 / $33.11
| Professional | 26 | $7.94 | $11.22 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $28.18 / $53.70
| Professional | TC | $16.98 | $28.18 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $23.44 / $41.69
| Professional | | $19.05 | $23.44 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.46 / $8.32 / $15.49
| Professional | 26 | $6.46 | $8.32 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.13 / $20.42 / $34.67
| Professional | TC | $14.13 | $20.42 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $199.53 / $354.81
| Facility | | $117.49 | $199.53 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $25.70 / $41.69
| Professional | | $25.12 | $25.70 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $8.91 / $14.13
| Professional | 26 | $8.71 | $8.91 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.22 / $16.60 / $28.18
| Professional | TC | $16.22 | $16.60 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $24.55 / $38.02
| Facility | | $9.12 | $24.55 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $23.44 / $37.15
| Professional | | $8.91 | $23.44 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $64.57 / $199.53
| Facility | | $28.18 | $64.57 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $34.67 / $58.88
| Professional | | $22.91 | $34.67 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $11.22 / $18.20
| Professional | 26 | $7.41 | $11.22 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $23.44 / $41.69
| Professional | TC | $16.98 | $23.44 | $41.69 |
- 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
- $25.12 / $30.20 / $58.88
| Professional | | $25.12 | $30.20 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $10.23 / $31.62
| Professional | 26 | $8.13 | $10.23 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $20.42 / $41.69
| Professional | TC | $16.60 | $20.42 | $41.69 |