- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $275.42 / $691.83
| Facility | | $51.29 | $275.42 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $14.13 / $18.20
| Facility | 26 | $10.96 | $14.13 | $18.20 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $138.04 / $323.59
| Facility | TC | $30.90 | $138.04 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $52.48 / $131.83
| Professional | | $32.36 | $52.48 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $16.98 / $42.66
| Professional | 26 | $9.77 | $16.98 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $34.67 / $72.44
| Professional | TC | $21.88 | $34.67 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $128.82 / $208.93
| Facility | | $93.33 | $128.82 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $52.48 / $79.43
| Professional | | $34.67 | $52.48 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $14.13 / $20.89
| Professional | 26 | $10.00 | $14.13 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $38.90 / $58.88
| Professional | TC | $22.39 | $38.90 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $125.89 / $354.81
| Facility | | $69.18 | $125.89 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $21.88
| Facility | 26 | $21.88 | $21.88 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $52.48
| Facility | TC | $52.48 | $52.48 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $45.71 / $83.18
| Professional | | $31.62 | $45.71 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $14.45 / $24.55
| Professional | 26 | $9.55 | $14.45 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $31.62 / $57.54
| Professional | TC | $21.88 | $31.62 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $64.57 / $173.78
| Professional | | $51.29 | $64.57 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $16.60 / $54.95
| Professional | 26 | $15.14 | $16.60 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $48.98 / $117.49
| Professional | TC | $44.67 | $48.98 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $41.69 / $60.26
| Professional | | $38.02 | $41.69 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $10.47 / $16.98
| Professional | 26 | $10.47 | $10.47 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $30.90 / $43.65
| Professional | TC | $27.54 | $30.90 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $181.97 / $181.97
| Facility | | $53.70 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $56.23 / $87.10
| Professional | | $35.48 | $56.23 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $18.62 / $33.88
| Professional | 26 | $10.96 | $18.62 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $37.15 / $67.61
| Professional | TC | $25.12 | $37.15 | $67.61 |