- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $213.80
| Facility | | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $36.31 / $91.20
| Professional | | $19.95 | $36.31 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.01 / $11.75 / $29.51
| Professional | 26 | $5.01 | $11.75 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $22.91 / $79.43
| Professional | TC | $15.85 | $22.91 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $15.49 / $15.49
| Professional | | $15.49 | $15.49 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.46 / $6.46 / $6.46
| Professional | 26 | $6.46 | $6.46 | $6.46 |
- 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
- $24.55 / $38.02 / $89.13
| Professional | | $24.55 | $38.02 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $11.22 / $34.67
| Professional | 26 | $6.03 | $11.22 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $26.92 / $51.29
| Professional | TC | $18.20 | $26.92 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $33.88 / $74.13
| Professional | | $29.51 | $33.88 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.31 / $8.32 / $12.88
| Professional | 26 | $6.31 | $8.32 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $26.30 / $61.66
| Professional | TC | $22.91 | $26.30 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $23.99 / $114.82
| Professional | | $14.79 | $23.99 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.24 / $4.37 / $102.33
| Professional | 26 | $3.24 | $4.37 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.48 / $20.89 / $95.50
| Professional | TC | $11.48 | $20.89 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $36.31 / $104.71
| Facility | | $27.54 | $36.31 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | 26 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $50.12 / $263.03
| Professional | | $19.05 | $50.12 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.37 / $9.33 / $144.54
| Professional | 26 | $4.37 | $9.33 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.45 / $40.74 / $223.87
| Professional | TC | $14.45 | $40.74 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $12.88 / $16.22
| Facility | | $3.24 | $12.88 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $31.62 / $70.79
| Professional | | $19.05 | $31.62 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.37 / $7.24 / $15.14
| Professional | 26 | $4.37 | $7.24 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.45 / $23.99 / $53.70
| Professional | TC | $14.45 | $23.99 | $53.70 |