- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $112.20 / $426.58
| Facility | | $34.67 | $112.20 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $10.96 / $16.22
| Facility | 26 | $8.51 | $10.96 | $16.22 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $141.25 / $389.05
| Facility | TC | $26.30 | $141.25 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $39.81 / $112.20
| Professional | | $25.70 | $39.81 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $13.18 / $30.20
| Professional | 26 | $7.08 | $13.18 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $26.30 / $50.12
| Professional | TC | $19.05 | $26.30 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $104.71 / $165.96
| Facility | | $75.86 | $104.71 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $43.65 / $66.07
| Professional | | $28.84 | $43.65 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $10.96 / $16.22
| Professional | 26 | $7.94 | $10.96 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $32.36 / $50.12
| Professional | TC | $19.50 | $32.36 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $125.89 / $354.81
| Facility | | $57.54 | $125.89 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $16.98 / $16.98
| Facility | 26 | $16.98 | $16.98 | $16.98 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $43.65 / $43.65
| Facility | TC | $43.65 | $43.65 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $38.90 / $67.61
| Professional | | $25.70 | $38.90 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $11.22 / $19.05
| Professional | 26 | $7.59 | $11.22 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $26.92 / $48.98
| Professional | TC | $17.78 | $26.92 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $52.48 / $151.36
| Professional | | $42.66 | $52.48 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $13.18 / $41.69
| Professional | 26 | $12.02 | $13.18 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $38.90 / $107.15
| Professional | TC | $35.48 | $38.90 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $33.88 / $50.12
| Professional | | $30.90 | $33.88 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $8.51 / $13.18
| Professional | 26 | $8.13 | $8.51 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $25.12 / $37.15
| Professional | TC | $22.91 | $25.12 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $181.97 / $181.97
| Facility | | $43.65 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $45.71 / $74.13
| Professional | | $29.51 | $45.71 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $14.45 / $26.30
| Professional | 26 | $8.51 | $14.45 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $31.62 / $56.23
| Professional | TC | $20.42 | $31.62 | $56.23 |