- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $79.43 / $302.00
| Facility | | $39.81 | $79.43 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $12.02 / $15.85
| Facility | 26 | $10.96 | $12.02 | $15.85 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $36.31 / $234.42
| Facility | TC | $25.12 | $36.31 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $32.36 / $112.20
| Professional | | $21.88 | $32.36 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $9.77 / $38.02
| Professional | 26 | $7.08 | $9.77 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $22.91 / $57.54
| Professional | TC | $15.14 | $22.91 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $19.50 / $19.95
| Professional | | $16.98 | $19.50 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.13 / $14.13 / $14.13
| Professional | TC | $14.13 | $14.13 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $331.13 / $537.03
| Facility | | $93.33 | $331.13 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $20.89 / $36.31
| Professional | | $6.31 | $20.89 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $19.95 / $19.95
| Facility | | $19.95 | $19.95 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $35.48 / $47.86
| Professional | | $22.91 | $35.48 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $11.48 / $16.60
| Professional | 26 | $7.24 | $11.48 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $22.91 / $33.11
| Professional | TC | $16.60 | $22.91 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $32.36 / $33.88
| Professional | | $15.49 | $32.36 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $35.48 / $63.10
| Facility | | $23.99 | $35.48 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $41.69 / $66.07
| Professional | | $25.70 | $41.69 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $11.48 / $16.60
| Professional | 26 | $7.41 | $11.48 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $22.91 / $33.11
| Professional | TC | $16.60 | $22.91 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $169.82 / $380.19
| Facility | | $11.75 | $169.82 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $29.51 / $67.61
| Professional | | $26.30 | $29.51 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $9.77 / $31.62
| Professional | 26 | $8.91 | $9.77 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $20.42 / $40.74
| Professional | TC | $17.38 | $20.42 | $40.74 |