- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $269.15 / $501.19
| Facility | | $77.62 | $269.15 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $10.96 / $28.84
| Facility | 26 | $8.91 | $10.96 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $61.66 / $426.58
| Facility | TC | $18.62 | $61.66 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $43.65 / $128.82
| Professional | | $26.92 | $43.65 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $13.18 / $54.95
| Professional | 26 | $8.91 | $13.18 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $26.92 / $58.88
| Professional | TC | $18.20 | $26.92 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $25.70 / $30.90
| Professional | | $21.38 | $25.70 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $8.51 / $9.77
| Professional | 26 | $7.76 | $8.51 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.13 / $16.98 / $29.51
| Professional | TC | $14.13 | $16.98 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $151.36 / $263.03
| Facility | | $79.43 | $151.36 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $109.65
| Facility | TC | $83.18 | $83.18 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $41.69 / $72.44
| Professional | | $32.36 | $41.69 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $19.50 / $30.90
| Professional | 26 | $10.23 | $19.50 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $22.91 / $37.15
| Professional | TC | $20.42 | $22.91 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $169.82 / $446.68
| Facility | | $91.20 | $169.82 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $38.02 / $60.26
| Professional | | $30.20 | $38.02 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $13.80 / $23.99
| Professional | 26 | $10.72 | $13.80 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $25.12 / $39.81
| Professional | TC | $18.62 | $25.12 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $38.02 / $70.79
| Facility | | $27.54 | $38.02 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $81.28 / $363.08
| Facility | | $48.98 | $81.28 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $37.15 / $63.10
| Professional | | $27.54 | $37.15 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $12.88 / $22.39
| Professional | 26 | $10.23 | $12.88 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $23.99 / $41.69
| Professional | TC | $16.98 | $23.99 | $41.69 |