- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $154.88 / $346.74
| Facility | | $34.67 | $154.88 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $8.51 / $8.51
| Facility | 26 | $6.92 | $8.51 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $36.31 / $100.00
| Professional | | $20.89 | $36.31 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.98 / $8.13 / $31.62
| Professional | 26 | $3.98 | $8.13 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $26.92 / $50.12
| Professional | TC | $15.85 | $26.92 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $29.51
| Professional | | $29.51 | $29.51 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.16 / $6.46 / $7.59
| Professional | 26 | $3.16 | $6.46 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $22.91
| Professional | TC | $22.91 | $22.91 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $38.90 / $63.10
| Professional | | $37.15 | $38.90 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $7.94 / $12.59
| Professional | 26 | $7.59 | $7.94 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $29.51 / $53.70
| Professional | TC | $28.18 | $29.51 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $31.62 / $31.62
| Facility | | $28.84 | $31.62 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.31 / $6.61 / $6.61
| Professional | 26 | $6.31 | $6.61 | $6.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $25.12 / $54.95
| Professional | | $14.45 | $25.12 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.09 / $4.68 / $11.22
| Professional | 26 | $3.09 | $4.68 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.48 / $20.89 / $45.71
| Professional | TC | $11.48 | $20.89 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $31.62 / $75.86
| Professional | | $17.78 | $31.62 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.37 / $7.24 / $12.59
| Professional | 26 | $4.37 | $7.24 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.80 / $25.12 / $63.10
| Professional | TC | $13.80 | $25.12 | $63.10 |