- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $104.71 / $338.84
| Facility | | $33.11 | $104.71 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $10.00 / $12.59
| Facility | 26 | $8.91 | $10.00 | $12.59 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $27.54 / $95.50
| Facility | TC | $23.44 | $27.54 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $40.74 / $93.33
| Professional | | $24.55 | $40.74 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $10.72 / $26.92
| Professional | 26 | $7.08 | $10.72 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $23.99 / $43.65
| Professional | TC | $16.98 | $23.99 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $22.91 / $43.65
| Professional | | $20.89 | $22.91 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.75 / $8.32 / $12.02
| Professional | 26 | $5.75 | $8.32 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.49 / $13.49 / $17.38
| Professional | TC | $13.49 | $13.49 | $17.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $95.50 / $181.97
| Facility | | $46.77 | $95.50 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $39.81 / $46.77
| Professional | | $33.88 | $39.81 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $11.48 / $14.13
| Professional | 26 | $9.12 | $11.48 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $28.84 / $33.11
| Professional | TC | $24.55 | $28.84 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $39.81 / $75.86
| Facility | | $30.20 | $39.81 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $22.39 / $39.81
| Facility | TC | $22.39 | $22.39 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $18.62 / $18.62
| Professional | 26 | $7.94 | $18.62 | $18.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $63.10 / $91.20
| Facility | | $42.66 | $63.10 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $30.20 / $58.88
| Professional | | $19.50 | $30.20 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.62 / $9.33 / $17.38
| Professional | 26 | $5.62 | $9.33 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.80 / $22.39 / $40.74
| Professional | TC | $13.80 | $22.39 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $131.83 / $218.78
| Facility | | $44.67 | $131.83 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $31.62 / $47.86
| Professional | | $22.39 | $31.62 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $9.12 / $13.49
| Professional | 26 | $6.92 | $9.12 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.49 / $21.88 / $33.11
| Professional | TC | $15.49 | $21.88 | $33.11 |