- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $107.15 / $275.42
| Facility | | $53.70 | $107.15 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $39.81 / $109.65
| Facility | 26 | $22.39 | $39.81 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $109.65 / $281.84
| Facility | TC | $31.62 | $109.65 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $72.44 / $186.21
| Professional | | $46.77 | $72.44 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $44.67 / $194.98
| Professional | 26 | $19.95 | $44.67 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $38.02 / $104.71
| Professional | TC | $26.92 | $38.02 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $36.31
| Facility | | $36.31 | $36.31 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $77.62 / $213.80
| Professional | | $40.74 | $77.62 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $36.31 / $109.65
| Professional | 26 | $22.39 | $36.31 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $39.81 / $104.71
| Professional | TC | $18.62 | $39.81 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $123.03 / $512.86
| Facility | | $48.98 | $123.03 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $67.61 / $117.49
| Facility | 26 | $14.45 | $67.61 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.48 / $61.66 / $151.36
| Facility | TC | $11.48 | $61.66 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $66.07 / $169.82
| Professional | | $32.36 | $66.07 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $30.20 / $83.18
| Professional | 26 | $13.18 | $30.20 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $37.15 / $85.11
| Professional | TC | $18.62 | $37.15 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $33.11 / $72.44
| Facility | | $16.98 | $33.11 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $74.13 / $199.53
| Professional | | $39.81 | $74.13 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $33.11 / $97.72
| Professional | 26 | $16.98 | $33.11 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $40.74 / $95.50
| Professional | TC | $22.91 | $40.74 | $95.50 |