- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $758.58 / $3,715.35
| Facility | TC | $190.55 | $758.58 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $19.50 / $47.86
| Professional | | $13.80 | $19.50 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $25.12 / $77.62
| Professional | 26 | $8.91 | $25.12 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.01 / $7.76 / $21.38
| Professional | TC | $5.01 | $7.76 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $10.00 / $12.59
| Professional | | $9.33 | $10.00 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.62 / $14.79 / $21.88
| Professional | 26 | $5.62 | $14.79 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $4.47 / $4.47 / $14.45
| Professional | TC | $4.47 | $4.47 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $21.38 / $43.65
| Professional | | $9.12 | $21.38 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.37 / $13.49 / $26.30
| Professional | 26 | $5.37 | $13.49 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.72 / $6.31 / $13.49
| Professional | TC | $3.72 | $6.31 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $16.98 / $36.31
| Facility | | $10.47 | $16.98 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $13.49 / $25.12
| Professional | | $8.91 | $13.49 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $18.62 / $53.70
| Professional | | $9.12 | $18.62 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.75 / $9.55 / $32.36
| Professional | 26 | $5.75 | $9.55 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2.75 / $4.68 / $22.39
| Professional | TC | $2.75 | $4.68 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $26.30 / $91.20
| Professional | | $18.20 | $26.30 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $17.38 / $64.57
| Professional | 26 | $10.23 | $17.38 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $7.76 / $12.88 / $26.30
| Professional | TC | $7.76 | $12.88 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $19.50 / $38.02
| Professional | | $8.91 | $19.50 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $10.47 / $18.20
| Facility | | $2.95 | $10.47 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $20.42 / $47.86
| Professional | | $12.30 | $20.42 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $12.88 / $30.20
| Professional | 26 | $7.59 | $12.88 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $4.79 / $6.76 / $18.20
| Professional | TC | $4.79 | $6.76 | $18.20 |