- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $426.58 / $977.24
| Facility | | $83.18 | $426.58 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $24.55
| Facility | 26 | $24.55 | $24.55 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $87.10 / $676.08
| Facility | TC | $47.86 | $87.10 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $69.18 / $81.28
| Professional | | $61.66 | $69.18 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $173.78 / $575.44
| Professional | 26 | $25.12 | $173.78 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $45.71 / $56.23
| Professional | TC | $42.66 | $45.71 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $77.62 / $120.23
| Facility | | $30.90 | $77.62 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $85.11 / $199.53
| Professional | | $30.90 | $85.11 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $177.83 / $177.83
| Facility | | $177.83 | $177.83 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $50.12 / $70.79
| Facility | 26 | $10.72 | $50.12 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.22 / $75.86 / $107.15
| Facility | TC | $16.22 | $75.86 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $117.49 / $446.68
| Professional | | $41.69 | $117.49 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $35.48 / $128.82
| Professional | 26 | $12.30 | $35.48 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $81.28 / $323.59
| Professional | TC | $28.84 | $81.28 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $123.03
| Professional | | $123.03 | $123.03 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $35.48 / $51.29
| Professional | 26 | $33.11 | $35.48 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $58.88 / $131.83
| Professional | | $38.02 | $58.88 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $19.05 / $41.69
| Professional | 26 | $14.45 | $19.05 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $39.81 / $75.86
| Professional | TC | $30.20 | $39.81 | $75.86 |