- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $213.80 / $758.58
| Facility | | $67.61 | $213.80 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $37.15 / $104.71
| Facility | 26 | $20.89 | $37.15 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $218.78 / $524.81
| Facility | TC | $74.13 | $218.78 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $120.23 / $524.81
| Professional | | $61.66 | $120.23 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $70.79 / $281.84
| Professional | 26 | $21.88 | $70.79 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $83.18 / $281.84
| Professional | TC | $52.48 | $83.18 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $57.54 / $141.25
| Facility | | $57.54 | $57.54 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $75.86 / $223.87
| Professional | | $35.48 | $75.86 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $28.18 / $63.10
| Professional | 26 | $11.22 | $28.18 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $7.08 / $40.74 / $169.82
| Professional | TC | $7.08 | $40.74 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $181.97 / $870.96
| Facility | | $48.98 | $181.97 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $36.31 / $91.20
| Facility | 26 | $6.92 | $36.31 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $107.15 / $316.23
| Facility | TC | $20.42 | $107.15 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $87.10 / $194.98
| Professional | | $44.67 | $87.10 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $25.70 / $53.70
| Professional | 26 | $12.59 | $25.70 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $61.66 / $151.36
| Professional | TC | $32.36 | $61.66 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $47.86 / $79.43
| Facility | | $16.22 | $47.86 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $100.00 / $257.04
| Professional | | $56.23 | $100.00 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $27.54 / $89.13
| Professional | 26 | $15.49 | $27.54 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $75.86 / $169.82
| Professional | TC | $42.66 | $75.86 | $169.82 |