- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $229.09 / $630.96
| Facility | | $45.71 | $229.09 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $10.47 / $15.49
| Facility | 26 | $7.94 | $10.47 | $15.49 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $173.78 / $436.52
| Facility | TC | $26.30 | $173.78 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $30.90 / $81.28
| Professional | | $10.23 | $30.90 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $12.02 / $38.02
| Professional | 26 | $7.08 | $12.02 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $26.30 / $56.23
| Professional | TC | $18.20 | $26.30 | $56.23 |
- 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
- $29.51 / $43.65 / $66.07
| Professional | | $29.51 | $43.65 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $10.47 / $15.85
| Professional | 26 | $7.76 | $10.47 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $32.36 / $50.12
| Professional | TC | $20.89 | $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
- $16.22 / $16.22 / $16.22
| Facility | 26 | $16.22 | $16.22 | $16.22 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $44.67
| Facility | TC | $44.67 | $44.67 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $38.90 / $67.61
| Professional | | $25.12 | $38.90 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $10.72 / $18.20
| Professional | 26 | $6.92 | $10.72 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $26.92 / $48.98
| Professional | TC | $18.20 | $26.92 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $52.48 / $138.04
| Professional | | $41.69 | $52.48 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $12.59 / $38.90
| Professional | 26 | $11.48 | $12.59 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $39.81 / $100.00
| Professional | TC | $36.31 | $39.81 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $33.88 / $48.98
| Professional | | $30.90 | $33.88 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $8.13 / $12.30
| Professional | 26 | $7.59 | $8.13 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $25.70 / $37.15
| Professional | TC | $22.91 | $25.70 | $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
- $28.84 / $45.71 / $72.44
| Professional | | $28.84 | $45.71 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $13.80 / $27.54
| Professional | 26 | $8.32 | $13.80 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $30.90 / $47.86
| Professional | TC | $20.42 | $30.90 | $47.86 |