- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $104.71 / $416.87
| Facility | | $33.88 | $104.71 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $10.47 / $19.50
| Facility | 26 | $8.13 | $10.47 | $19.50 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $38.90 / $281.84
| Facility | TC | $22.91 | $38.90 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $41.69 / $125.89
| Professional | | $25.70 | $41.69 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $12.30 / $30.90
| Professional | 26 | $7.08 | $12.30 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $27.54 / $57.54
| Professional | TC | $18.20 | $27.54 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $26.30 / $53.70
| Professional | | $23.44 | $26.30 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.31 / $8.91 / $14.13
| Professional | 26 | $6.31 | $8.91 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $39.81
| Professional | TC | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $33.88 / $57.54
| Professional | | $27.54 | $33.88 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $10.72 / $17.38
| Professional | 26 | $8.71 | $10.72 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $23.99 / $41.69
| Professional | TC | $19.05 | $23.99 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $30.90 / $58.88
| Facility | | $24.55 | $30.90 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $34.67 / $43.65
| Professional | | $32.36 | $34.67 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $9.33 / $12.30
| Professional | 26 | $9.12 | $9.33 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $25.70 / $30.90
| Professional | TC | $23.44 | $25.70 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $83.18 / $245.47
| Facility | | $52.48 | $83.18 | $245.47 |
- 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
- $5.62 / $26.30 / $38.02
| Facility | TC | $5.62 | $26.30 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $38.90 / $63.10
| Professional | | $25.12 | $38.90 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $11.48 / $20.42
| Professional | 26 | $7.24 | $11.48 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $28.18 / $52.48
| Professional | TC | $17.78 | $28.18 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $44.67 / $91.20
| Facility | | $28.18 | $44.67 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $100.00 / $100.00
| Facility | 26 | $19.50 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $51.29 / $109.65 / $109.65
| Facility | TC | $51.29 | $109.65 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $41.69 / $208.93
| Professional | | $28.18 | $41.69 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $12.30 / $83.18
| Professional | 26 | $8.51 | $12.30 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $29.51 / $177.83
| Professional | TC | $19.50 | $29.51 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $74.13 / $177.83
| Facility | | $30.20 | $74.13 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $34.67 / $69.18
| Professional | | $28.18 | $34.67 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $10.23 / $23.99
| Professional | 26 | $8.13 | $10.23 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $24.55 / $50.12
| Professional | TC | $19.50 | $24.55 | $50.12 |