- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $131.83 / $295.12
| Facility | | $31.62 | $131.83 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $10.96 / $12.88
| Facility | 26 | $10.00 | $10.96 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $26.30 / $251.19
| Facility | TC | $20.89 | $26.30 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $34.67 / $75.86
| Professional | | $22.91 | $34.67 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $10.00 / $36.31
| Professional | 26 | $7.08 | $10.00 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $21.88 / $48.98
| Professional | TC | $15.14 | $21.88 | $48.98 |
- 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
- $6.03 / $8.32 / $9.33
| Professional | 26 | $6.03 | $8.32 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.13 / $16.60 / $36.31
| Professional | TC | $14.13 | $16.60 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $47.86 / $95.50
| Facility | | $28.84 | $47.86 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $37.15 / $43.65
| Professional | | $31.62 | $37.15 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $11.48 / $14.79
| Professional | 26 | $9.55 | $11.48 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $25.70 / $28.84
| Professional | TC | $21.88 | $25.70 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $28.84 / $74.13
| Facility | | $27.54 | $28.84 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $19.95 / $19.95
| Facility | TC | $19.50 | $19.95 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $8.91 / $14.45
| Professional | 26 | $8.13 | $8.91 | $14.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $42.66 / $91.20
| Facility | | $40.74 | $42.66 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $27.54 / $52.48
| Professional | | $19.05 | $27.54 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $9.55 / $17.78
| Professional | 26 | $6.17 | $9.55 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.59 / $19.50 / $36.31
| Professional | TC | $12.59 | $19.50 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $131.83 / $218.78
| Facility | | $61.66 | $131.83 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $28.84 / $44.67
| Professional | | $20.89 | $28.84 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $9.33 / $14.45
| Professional | 26 | $7.24 | $9.33 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.49 / $19.05 / $28.84
| Professional | TC | $13.49 | $19.05 | $28.84 |