- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $338.84 / $794.33
| Facility | | $43.65 | $338.84 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $47.86 / $64.57
| Facility | 26 | $19.95 | $47.86 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $39.81 / $104.71
| Professional | | $28.18 | $39.81 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $20.89 / $70.79
| Professional | 26 | $12.02 | $20.89 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $25.12 / $54.95
| Professional | TC | $16.98 | $25.12 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $28.84 / $30.90
| Professional | | $27.54 | $28.84 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $10.72 / $13.49
| Professional | 26 | $9.33 | $10.72 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $50.12 / $95.50
| Facility | | $11.22 | $50.12 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $38.02 / $66.07
| Professional | | $33.11 | $38.02 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $12.30 / $21.38
| Professional | 26 | $10.72 | $12.30 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $25.12 / $44.67
| Professional | TC | $22.39 | $25.12 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $69.18 / $83.18
| Facility | | $57.54 | $69.18 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $41.69 / $75.86
| Professional | | $30.20 | $41.69 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $16.98 / $28.18
| Professional | 26 | $11.75 | $16.98 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $24.55 / $47.86
| Professional | TC | $18.20 | $24.55 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $43.65 / $79.43
| Facility | | $34.67 | $43.65 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $100.00 / $100.00
| Facility | 26 | $31.62 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $38.90 / $288.40
| Professional | | $31.62 | $38.90 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $16.22 / $204.17
| Professional | 26 | $13.49 | $16.22 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $22.91 / $229.09
| Professional | TC | $17.78 | $22.91 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $17.78 / $38.02
| Facility | | $12.30 | $17.78 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $37.15 / $61.66
| Professional | | $31.62 | $37.15 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $15.85 / $47.86
| Professional | 26 | $13.49 | $15.85 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $22.39 / $37.15
| Professional | TC | $17.78 | $22.39 | $37.15 |