- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $239.88 / $741.31
| Facility | | $45.71 | $239.88 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $11.48 / $17.78
| Facility | 26 | $8.91 | $11.48 | $17.78 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $288.40 / $588.84
| Facility | TC | $23.44 | $288.40 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $26.92 / $79.43
| Professional | | $19.05 | $26.92 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $9.12 / $38.02
| Professional | 26 | $7.94 | $9.12 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.47 / $16.98 / $34.67
| Professional | TC | $10.47 | $16.98 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $81.28 / $131.83
| Facility | | $60.26 | $81.28 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $34.67 / $52.48
| Professional | | $20.42 | $34.67 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $11.48 / $16.98
| Professional | 26 | $7.94 | $11.48 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.72 / $22.91 / $35.48
| Professional | TC | $10.72 | $22.91 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $173.78 / $354.81
| Facility | | $31.62 | $173.78 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $17.78 / $17.78
| Facility | 26 | $17.78 | $17.78 | $17.78 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $31.62
| Facility | TC | $31.62 | $31.62 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $27.54 / $53.70
| Professional | | $18.20 | $27.54 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $11.75 / $19.95
| Professional | 26 | $7.59 | $11.75 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.23 / $16.60 / $33.88
| Professional | TC | $10.23 | $16.60 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $41.69 / $112.20
| Professional | | $38.02 | $41.69 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $12.02 / $13.18
| Professional | 26 | $12.02 | $12.02 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $28.18
| Professional | TC | $25.70 | $25.70 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $26.30 / $39.81
| Professional | | $25.12 | $26.30 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $8.51 / $13.80
| Professional | 26 | $8.51 | $8.51 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.22 / $18.20 / $26.30
| Professional | TC | $16.22 | $18.20 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $181.97 / $181.97
| Facility | | $34.67 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $35.48 / $61.66
| Professional | | $20.42 | $35.48 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $15.14 / $30.20
| Professional | 26 | $9.33 | $15.14 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.72 / $21.38 / $41.69
| Professional | TC | $10.72 | $21.38 | $41.69 |