- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $269.15 / $363.08
| Facility | | $213.80 | $269.15 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $32.36
| Facility | 26 | $32.36 | $32.36 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $724.44
| Facility | TC | $147.91 | $147.91 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $83.18 / $389.05
| Professional | | $43.65 | $83.18 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $43.65 / $173.78
| Professional | 26 | $8.91 | $43.65 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $64.57 / $169.82
| Professional | TC | $37.15 | $64.57 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $42.66 / $112.20
| Professional | | $27.54 | $42.66 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.75 / $12.59 / $19.95
| Professional | 26 | $5.75 | $12.59 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $50.12
| Professional | TC | $33.11 | $33.11 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $66.07 / $83.18
| Professional | | $53.70 | $66.07 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $52.48 / $109.65
| Professional | | $32.36 | $52.48 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.89 / $10.00 / $19.95
| Professional | 26 | $5.89 | $10.00 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $45.71 / $89.13
| Professional | TC | $28.18 | $45.71 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $63.10 / $128.82
| Professional | | $40.74 | $63.10 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $13.49 / $21.88
| Professional | 26 | $8.71 | $13.49 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $52.48 / $104.71
| Professional | TC | $27.54 | $52.48 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $33.11 / $93.33
| Professional | | $16.22 | $33.11 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $28.84 / $56.23
| Facility | | $4.79 | $28.84 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $46.77 / $154.88
| Professional | | $35.48 | $46.77 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.89 / $7.76 / $30.90
| Professional | 26 | $5.89 | $7.76 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $38.90 / $128.82
| Professional | TC | $29.51 | $38.90 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $63.10 / $83.18
| Professional | | $28.18 | $63.10 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.98 / $8.91 / $11.75
| Professional | 26 | $3.98 | $8.91 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $53.70 / $70.79
| Professional | TC | $23.99 | $53.70 | $70.79 |