- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $309.03 / $562.34
| Facility | | $36.31 | $309.03 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $9.12 / $13.49
| Facility | 26 | $7.94 | $9.12 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $331.13 / $602.56
| Facility | TC | $48.98 | $331.13 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $30.90 / $63.10
| Professional | | $22.91 | $30.90 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $11.75 / $28.84
| Professional | 26 | $7.08 | $11.75 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $20.89 / $38.02
| Professional | TC | $15.85 | $20.89 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $24.55 / $40.74
| Facility | | $10.23 | $24.55 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $26.92 / $58.88
| Professional | | $10.96 | $26.92 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $61.66 / $223.87
| Facility | | $43.65 | $61.66 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.04 / $9.55 / $13.49
| Facility | 26 | $2.04 | $9.55 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $4.57 / $21.38 / $30.20
| Facility | TC | $4.57 | $21.38 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $37.15 / $131.83
| Professional | | $21.38 | $37.15 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $12.02 / $41.69
| Professional | 26 | $6.76 | $12.02 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.79 / $25.12 / $91.20
| Professional | TC | $14.79 | $25.12 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $363.08 / $616.60
| Facility | | $102.33 | $363.08 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $107.15 / $239.88 / $457.09
| Facility | TC | $107.15 | $239.88 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $74.13 / $74.13
| Professional | | $42.66 | $74.13 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $14.13 / $21.88
| Professional | 26 | $11.48 | $14.13 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $35.48
| Professional | TC | $31.62 | $31.62 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $295.12 / $295.12
| Facility | | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $30.90 / $54.95
| Professional | | $20.42 | $30.90 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $10.00 / $20.42
| Professional | 26 | $6.17 | $10.00 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.80 / $20.89 / $38.02
| Professional | TC | $13.80 | $20.89 | $38.02 |