- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $288.40 / $933.25
| Facility | | $87.10 | $288.40 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $38.90 / $112.20
| Facility | 26 | $22.91 | $38.90 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $229.09 / $891.25
| Facility | TC | $64.57 | $229.09 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $134.90 / $812.83
| Professional | | $61.66 | $134.90 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $117.49 / $758.58
| Professional | 26 | $22.91 | $117.49 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $67.61 / $389.05
| Professional | TC | $38.90 | $67.61 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $74.13 / $190.55
| Professional | | $38.02 | $74.13 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $24.55 / $60.26
| Professional | 26 | $12.02 | $24.55 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $48.98 / $134.90
| Professional | TC | $25.70 | $48.98 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $169.82 / $691.83
| Facility | | $61.66 | $169.82 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $57.54 / $97.72
| Facility | 26 | $10.72 | $57.54 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.22 / $85.11 / $234.42
| Facility | TC | $16.22 | $85.11 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $72.44 / $169.82
| Professional | | $33.88 | $72.44 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $23.44 / $51.29
| Professional | 26 | $11.22 | $23.44 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $48.98 / $120.23
| Professional | TC | $22.91 | $48.98 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $44.67 / $74.13
| Facility | | $19.05 | $44.67 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $91.20 / $239.88
| Professional | | $47.86 | $91.20 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $29.51 / $95.50
| Professional | 26 | $14.79 | $29.51 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $61.66 / $141.25
| Professional | TC | $33.11 | $61.66 | $141.25 |