- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $269.15 / $776.25
| Facility | | $67.61 | $269.15 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $89.13 / $245.47
| Facility | 26 | $50.12 | $89.13 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $117.49 / $436.52
| Facility | TC | $32.36 | $117.49 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $95.50 / $251.19
| Professional | | $64.57 | $95.50 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $165.96 / $758.58
| Professional | 26 | $52.48 | $165.96 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $34.67 / $81.28
| Professional | TC | $23.99 | $34.67 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $102.33 / $223.87
| Professional | | $39.81 | $102.33 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $70.79 / $147.91
| Professional | 26 | $26.92 | $70.79 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.49 / $28.84 / $79.43
| Professional | TC | $13.49 | $28.84 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $158.49 / $758.58
| Facility | | $66.07 | $158.49 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $77.62 / $213.80
| Facility | 26 | $14.45 | $77.62 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $9.55 / $50.12 / $151.36
| Facility | TC | $9.55 | $50.12 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $91.20 / $186.21
| Professional | | $45.71 | $91.20 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $58.88 / $125.89
| Professional | 26 | $28.84 | $58.88 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.79 / $28.84 / $72.44
| Professional | TC | $14.79 | $28.84 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $47.86 / $97.72
| Facility | | $19.95 | $47.86 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $95.50 / $204.17
| Professional | | $53.70 | $95.50 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $64.57 / $158.49
| Professional | 26 | $35.48 | $64.57 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $33.11 / $75.86
| Professional | TC | $18.62 | $33.11 | $75.86 |