- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $66.07 / $512.86
| Facility | | $57.54 | $66.07 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $13.18 / $19.05
| Facility | 26 | $13.18 | $13.18 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $52.48
| Facility | TC | $33.11 | $33.11 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $57.54 / $138.04
| Professional | | $29.51 | $57.54 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $13.80 / $52.48
| Professional | 26 | $7.94 | $13.80 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $32.36 / $53.70
| Professional | TC | $21.38 | $32.36 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $28.84 / $53.70
| Professional | | $7.94 | $28.84 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $69.18 / $95.50
| Professional | | $38.90 | $69.18 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $13.49 / $18.20
| Professional | 26 | $10.96 | $13.49 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $56.23 / $77.62
| Professional | TC | $27.54 | $56.23 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $60.26 / $95.50
| Facility | | $38.02 | $60.26 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $81.28 / $114.82
| Professional | | $39.81 | $81.28 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $14.45 / $18.20
| Professional | 26 | $11.22 | $14.45 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $56.23 / $77.62
| Professional | TC | $28.84 | $56.23 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $37.15 / $91.20
| Professional | | $25.12 | $37.15 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.46 / $7.08 / $22.39
| Professional | 26 | $6.46 | $7.08 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $30.20 / $57.54
| Professional | TC | $17.78 | $30.20 | $57.54 |