- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $151.36 / $380.19
| Facility | | $33.11 | $151.36 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $10.00 / $13.49
| Facility | 26 | $8.91 | $10.00 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $28.84 / $109.65
| Facility | TC | $23.99 | $28.84 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $33.11 / $70.79
| Professional | | $10.47 | $33.11 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $10.00 / $33.88
| Professional | 26 | $6.03 | $10.00 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $25.12 / $46.77
| Professional | TC | $16.98 | $25.12 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $20.89 / $23.99
| Professional | | $19.05 | $20.89 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $7.76 / $10.72
| Professional | 26 | $6.17 | $7.76 | $10.72 |
- 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
- $33.11 / $38.90 / $46.77
| Professional | | $33.11 | $38.90 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $10.47 / $14.13
| Professional | 26 | $8.51 | $10.47 | $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
- $29.51 / $39.81 / $87.10
| Facility | | $29.51 | $39.81 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $22.91 / $39.81
| Facility | TC | $22.39 | $22.91 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $21.88 / $21.88
| Professional | 26 | $7.24 | $21.88 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $64.57 / $93.33
| Facility | | $42.66 | $64.57 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $29.51 / $58.88
| Professional | | $19.95 | $29.51 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.37 / $8.91 / $16.60
| Professional | 26 | $5.37 | $8.91 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.45 / $22.39 / $40.74
| Professional | TC | $14.45 | $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 / $48.98
| Professional | | $22.39 | $31.62 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $8.71 / $12.88
| Professional | 26 | $6.76 | $8.71 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $21.88 / $33.11
| Professional | TC | $15.85 | $21.88 | $33.11 |