- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $173.78 / $741.31
| Facility | | $58.88 | $173.78 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $16.60 / $47.86
| Facility | 26 | $9.55 | $16.60 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $257.04 / $724.44
| Facility | TC | $58.88 | $257.04 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $89.13 / $316.23
| Professional | | $51.29 | $89.13 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $39.81 / $128.82
| Professional | 26 | $10.00 | $39.81 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $69.18 / $173.78
| Professional | TC | $42.66 | $69.18 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $23.44 / $23.44
| Facility | | $23.44 | $23.44 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $56.23 / $173.78
| Professional | | $26.30 | $56.23 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.01 / $13.49 / $30.90
| Professional | 26 | $5.01 | $13.49 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $36.31 / $144.54
| Professional | TC | $18.20 | $36.31 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $131.83 / $630.96
| Facility | | $30.90 | $131.83 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.02 / $16.22 / $40.74
| Facility | 26 | $3.02 | $16.22 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $89.13 / $263.03
| Facility | TC | $16.98 | $89.13 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $61.66 / $144.54
| Professional | | $32.36 | $61.66 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.62 / $11.48 / $25.12
| Professional | 26 | $5.62 | $11.48 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $51.29 / $123.03
| Professional | TC | $26.92 | $51.29 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $33.88 / $67.61
| Facility | | $8.13 | $33.88 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $77.62 / $177.83
| Professional | | $41.69 | $77.62 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $12.59 / $50.12
| Professional | 26 | $6.92 | $12.59 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $60.26 / $128.82
| Professional | TC | $34.67 | $60.26 | $128.82 |