- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $128.82 / $436.52
| Facility | | $33.88 | $128.82 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $33.88 / $83.18
| Facility | 26 | $10.00 | $33.88 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $74.13 / $218.78
| Facility | TC | $23.99 | $74.13 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $42.66 / $112.20
| Professional | | $23.99 | $42.66 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $11.22 / $39.81
| Professional | 26 | $7.94 | $11.22 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $25.12 / $57.54
| Professional | TC | $16.60 | $25.12 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $21.88 / $28.18
| Professional | | $17.78 | $21.88 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.75 / $7.08 / $12.59
| Professional | 26 | $5.75 | $7.08 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.49 / $16.98 / $22.91
| Professional | TC | $13.49 | $16.98 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $63.10 / $123.03
| Facility | | $16.22 | $63.10 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $32.36 / $131.83
| Professional | | $26.92 | $32.36 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $9.77 / $15.49
| Professional | 26 | $7.76 | $9.77 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $22.91 / $93.33
| Professional | TC | $19.05 | $22.91 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $208.93 / $269.15
| Facility | | $128.82 | $208.93 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.14 / $10.00 / $14.13
| Facility | 26 | $2.14 | $10.00 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.01 / $23.44 / $33.11
| Facility | TC | $5.01 | $23.44 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $32.36 / $63.10
| Professional | | $23.44 | $32.36 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $10.47 / $19.05
| Professional | 26 | $7.24 | $10.47 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.22 / $21.38 / $42.66
| Professional | TC | $16.22 | $21.38 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $33.88 / $154.88
| Facility | | $25.70 | $33.88 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $70.79 / $70.79
| Facility | 26 | $20.42 | $70.79 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $97.72 / $97.72
| Facility | TC | $44.67 | $97.72 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $29.51 / $194.98
| Professional | | $26.30 | $29.51 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $10.23 / $54.95
| Professional | 26 | $8.71 | $10.23 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $20.42 / $138.04
| Professional | TC | $17.38 | $20.42 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $74.13 / $95.50
| Facility | | $13.18 | $74.13 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $29.51 / $85.11
| Professional | | $26.30 | $29.51 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $9.77 / $53.70
| Professional | 26 | $8.71 | $9.77 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $20.42 / $63.10
| Professional | TC | $17.38 | $20.42 | $63.10 |