- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $316.23 / $758.58
| Facility | | $58.88 | $316.23 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $13.49 / $17.78
| Facility | 26 | $10.72 | $13.49 | $17.78 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $177.83 / $645.65
| Facility | TC | $31.62 | $177.83 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $46.77 / $128.82
| Professional | | $28.18 | $46.77 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $13.80 / $50.12
| Professional | 26 | $9.12 | $13.80 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $27.54 / $64.57
| Professional | TC | $18.62 | $27.54 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $107.15 / $169.82
| Facility | | $77.62 | $107.15 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $45.71 / $67.61
| Professional | | $30.90 | $45.71 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $13.80 / $20.42
| Professional | 26 | $9.77 | $13.80 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $30.90 / $47.86
| Professional | TC | $19.50 | $30.90 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $173.78 / $354.81
| Facility | | $41.69 | $173.78 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $20.89 / $20.89
| Facility | 26 | $20.89 | $20.89 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $42.66
| Facility | TC | $42.66 | $42.66 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $39.81 / $69.18
| Professional | | $27.54 | $39.81 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $13.80 / $23.44
| Professional | 26 | $9.33 | $13.80 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $25.70 / $46.77
| Professional | TC | $17.78 | $25.70 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $53.70 / $165.96
| Professional | | $48.98 | $53.70 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $14.45 / $15.85
| Professional | 26 | $14.45 | $14.45 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $38.02
| Professional | TC | $34.67 | $34.67 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $34.67 / $51.29
| Professional | | $32.36 | $34.67 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $10.23 / $16.60
| Professional | 26 | $10.23 | $10.23 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $24.55 / $35.48
| Professional | TC | $21.88 | $24.55 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $181.97 / $181.97
| Facility | | $45.71 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $50.12 / $83.18
| Professional | | $30.90 | $50.12 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $17.78 / $33.11
| Professional | 26 | $11.22 | $17.78 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $30.90 / $57.54
| Professional | TC | $19.95 | $30.90 | $57.54 |