- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $158.49 / $173.78
| Facility | | $87.10 | $158.49 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $28.18 / $28.18
| Facility | 26 | $15.49 | $28.18 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $131.83 / $389.05
| Facility | TC | $70.79 | $131.83 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $131.83 / $426.58
| Professional | | $43.65 | $131.83 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $54.95 / $165.96
| Professional | 26 | $20.42 | $54.95 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $52.48 / $186.21
| Professional | TC | $43.65 | $52.48 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $70.79
| Facility | | $64.57 | $64.57 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $83.18 / $114.82
| Professional | | $57.54 | $83.18 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $11.48 / $16.60
| Professional | 26 | $8.13 | $11.48 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $50.12 / $53.70 / $70.79
| Professional | TC | $50.12 | $53.70 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $102.33
| Facility | | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $42.66 / $144.54
| Professional | | $21.38 | $42.66 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $16.60 / $20.89
| Professional | 26 | $6.17 | $16.60 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $41.69 / $125.89
| Professional | TC | $31.62 | $41.69 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $81.28 / $109.65
| Professional | | $25.70 | $81.28 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $12.88 / $19.05
| Professional | 26 | $6.17 | $12.88 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $67.61 / $91.20
| Professional | TC | $19.50 | $67.61 | $91.20 |