- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $123.03 / $524.81
| Facility | | $38.02 | $123.03 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $15.14 / $44.67
| Facility | 26 | $8.91 | $15.14 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $144.54 / $467.74
| Facility | TC | $32.36 | $144.54 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $57.54 / $218.78
| Professional | | $29.51 | $57.54 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $23.99 / $81.28
| Professional | 26 | $8.91 | $23.99 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $36.31 / $91.20
| Professional | TC | $19.95 | $36.31 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $28.18
| Facility | | $28.18 | $28.18 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $51.29 / $123.03
| Professional | | $24.55 | $51.29 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.90 / $16.98 / $33.88
| Professional | 26 | $4.90 | $16.98 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $34.67 / $91.20
| Professional | TC | $19.50 | $34.67 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $95.50 / $323.59
| Facility | | $30.20 | $95.50 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.69 / $14.13 / $38.02
| Facility | 26 | $2.69 | $14.13 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.75 / $61.66 / $114.82
| Facility | TC | $11.75 | $61.66 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $39.81 / $95.50
| Professional | | $19.95 | $39.81 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.25 / $10.96 / $25.70
| Professional | 26 | $5.25 | $10.96 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.45 / $28.84 / $74.13
| Professional | TC | $14.45 | $28.84 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $19.95 / $75.86
| Facility | | $8.91 | $19.95 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $44.67 / $120.23
| Professional | | $24.55 | $44.67 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.46 / $12.02 / $57.54
| Professional | 26 | $6.46 | $12.02 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $31.62 / $81.28
| Professional | TC | $17.38 | $31.62 | $81.28 |