- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $87.10 / $363.08
| Facility | | $52.48 | $87.10 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $33.88 / $39.81
| Facility | 26 | $10.47 | $33.88 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $63.10 / $309.03
| Facility | TC | $40.74 | $63.10 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $41.69 / $112.20
| Professional | | $21.88 | $41.69 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $9.55 / $28.84
| Professional | 26 | $7.08 | $9.55 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.79 / $22.91 / $66.07
| Professional | TC | $14.79 | $22.91 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $58.88 / $89.13
| Facility | | $34.67 | $58.88 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $36.31 / $64.57
| Professional | | $24.55 | $36.31 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $11.48 / $19.95
| Professional | 26 | $6.92 | $11.48 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $25.12 / $44.67
| Professional | TC | $16.98 | $25.12 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $87.10 / $199.53
| Facility | | $46.77 | $87.10 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $42.66 / $77.62
| Professional | | $30.20 | $42.66 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $12.59 / $19.95
| Professional | 26 | $9.55 | $12.59 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $29.51 / $60.26
| Professional | TC | $22.39 | $29.51 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $34.67 / $47.86
| Professional | | $26.92 | $34.67 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $11.48 / $13.80
| Professional | 26 | $8.71 | $11.48 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $28.84 / $33.88
| Professional | TC | $18.20 | $28.84 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $204.17 / $234.42
| Facility | | $81.28 | $204.17 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $17.38 / $58.88
| Professional | | $12.30 | $17.38 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $37.15 / $85.11
| Professional | | $24.55 | $37.15 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $10.72 / $28.18
| Professional | 26 | $7.41 | $10.72 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $26.30 / $70.79
| Professional | TC | $16.98 | $26.30 | $70.79 |