- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $234.42 / $416.87
| Facility | | $36.31 | $234.42 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $10.47 / $13.80
| Facility | 26 | $7.76 | $10.47 | $13.80 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $25.12 / $61.66
| Facility | TC | $17.38 | $25.12 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $37.15 / $81.28
| Professional | | $21.88 | $37.15 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $10.47 / $27.54
| Professional | 26 | $7.08 | $10.47 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $22.39 / $43.65
| Professional | TC | $15.14 | $22.39 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $23.99 / $38.90
| Professional | | $18.62 | $23.99 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.46 / $9.55 / $15.49
| Professional | 26 | $6.46 | $9.55 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.49 / $19.50 / $34.67
| Professional | TC | $15.49 | $19.50 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $263.03 / $426.58
| Facility | | $28.84 | $263.03 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $42.66 / $114.82
| Professional | | $25.70 | $42.66 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $11.48 / $17.78
| Professional | 26 | $8.71 | $11.48 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.22 / $26.92 / $95.50
| Professional | TC | $16.22 | $26.92 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $22.91 / $35.48
| Facility | | $8.71 | $22.91 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $21.38 / $34.67
| Professional | | $8.71 | $21.38 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $199.53 / $199.53
| Facility | | $58.88 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $36.31 / $60.26
| Professional | | $23.99 | $36.31 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $11.22 / $18.20
| Professional | 26 | $7.41 | $11.22 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.22 / $24.55 / $41.69
| Professional | TC | $16.22 | $24.55 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $87.10 / $87.10
| Facility | | $11.22 | $87.10 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $30.20 / $56.23
| Professional | | $24.55 | $30.20 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $9.77 / $30.20
| Professional | 26 | $7.76 | $9.77 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $20.42 / $39.81
| Professional | TC | $16.60 | $20.42 | $39.81 |