- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $114.82 / $218.78
| Facility | | $38.02 | $114.82 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $12.02 / $14.79
| Facility | 26 | $9.33 | $12.02 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $37.15 / $125.89
| Facility | TC | $26.92 | $37.15 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $38.02 / $72.44
| Professional | | $26.92 | $38.02 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $12.02 / $38.02
| Professional | 26 | $7.08 | $12.02 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $26.92 / $47.86
| Professional | TC | $18.20 | $26.92 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $23.44 / $40.74
| Professional | | $23.44 | $23.44 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.75 / $8.32 / $9.55
| Professional | 26 | $5.75 | $8.32 | $9.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $117.49 / $269.15
| Facility | | $53.70 | $117.49 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $43.65 / $56.23
| Professional | | $37.15 | $43.65 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $13.18 / $19.50
| Professional | 26 | $9.55 | $13.18 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $32.36 / $38.90
| Professional | TC | $27.54 | $32.36 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $39.81 / $112.20
| Facility | | $33.11 | $39.81 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $25.70 / $39.81
| Facility | TC | $25.12 | $25.70 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $8.71 / $39.81
| Professional | 26 | $8.13 | $8.71 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $72.44 / $107.15
| Facility | | $47.86 | $72.44 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $37.15 / $70.79
| Professional | | $23.44 | $37.15 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $10.96 / $22.91
| Professional | 26 | $6.17 | $10.96 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.22 / $25.12 / $47.86
| Professional | TC | $16.22 | $25.12 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $162.18 / $263.03
| Facility | | $46.77 | $162.18 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $36.31 / $56.23
| Professional | | $26.92 | $36.31 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $10.47 / $17.78
| Professional | 26 | $8.51 | $10.47 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $24.55 / $36.31
| Professional | TC | $17.78 | $24.55 | $36.31 |