- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $102.33 / $831.76
| Facility | | $70.79 | $102.33 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $74.13 / $74.13
| Facility | 26 | $74.13 | $74.13 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $38.02 / $102.33
| Professional | | $24.55 | $38.02 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.09 / $16.98 / $77.62
| Professional | 26 | $3.09 | $16.98 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.13 / $21.88 / $52.48
| Professional | TC | $14.13 | $21.88 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $79.43 / $93.33
| Facility | | $60.26 | $79.43 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $47.86 / $75.86
| Professional | | $36.31 | $47.86 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $16.60 / $29.51
| Professional | 26 | $11.48 | $16.60 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $30.20 / $40.74
| Professional | TC | $21.88 | $30.20 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $95.50
| Facility | | $95.50 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $47.86 / $79.43
| Professional | | $33.11 | $47.86 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $19.05 / $30.20
| Professional | 26 | $10.96 | $19.05 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $35.48 / $51.29
| Professional | TC | $18.20 | $35.48 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $41.69 / $67.61
| Professional | | $29.51 | $41.69 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $16.60 / $26.92
| Professional | 26 | $13.80 | $16.60 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $25.70 / $42.66
| Professional | TC | $17.78 | $25.70 | $42.66 |