- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $107.15 / $316.23
| Facility | | $33.88 | $107.15 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $11.48 / $13.49
| Facility | 26 | $10.47 | $11.48 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $28.18 / $194.98
| Facility | TC | $23.44 | $28.18 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $32.36 / $69.18
| Professional | | $12.59 | $32.36 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.31 / $10.23 / $30.20
| Professional | 26 | $6.31 | $10.23 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $25.12 / $47.86
| Professional | TC | $16.98 | $25.12 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $30.90 / $39.81
| Professional | | $25.12 | $30.90 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $8.51 / $12.88
| Professional | 26 | $6.17 | $8.51 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $104.71
| Facility | | $75.86 | $75.86 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $36.31 / $46.77
| Professional | | $31.62 | $36.31 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $10.72 / $13.80
| Professional | 26 | $9.33 | $10.72 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $25.12 / $32.36
| Professional | TC | $21.88 | $25.12 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $28.84 / $50.12
| Facility | | $9.77 | $28.84 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $26.92 / $48.98
| Professional | | $8.51 | $26.92 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $52.48 / $162.18
| Facility | | $31.62 | $52.48 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.86 / $8.71 / $12.59
| Facility | 26 | $1.86 | $8.71 | $12.59 |
- 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
- $26.30 / $37.15 / $58.88
| Professional | | $26.30 | $37.15 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $10.72 / $16.22
| Professional | 26 | $7.41 | $10.72 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $25.70 / $41.69
| Professional | TC | $18.20 | $25.70 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $47.86 / $60.26
| Professional | | $36.31 | $47.86 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $13.49 / $17.38
| Professional | 26 | $6.92 | $13.49 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $25.70 / $47.86
| Professional | TC | $17.38 | $25.70 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $141.25 / $251.19
| Facility | | $89.13 | $141.25 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $33.11 / $63.10
| Professional | | $27.54 | $33.11 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $9.77 / $16.60
| Professional | 26 | $7.76 | $9.77 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $22.91 / $43.65
| Professional | TC | $19.50 | $22.91 | $43.65 |