- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $44.67 / $79.43
| Facility | | $41.69 | $44.67 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $25.12 / $45.71
| Facility | 26 | $23.99 | $25.12 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $42.66 / $95.50
| Professional | | $36.31 | $42.66 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $85.11 / $398.11
| Professional | 26 | $22.91 | $85.11 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.02 / $18.20 / $40.74
| Professional | TC | $12.02 | $18.20 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $54.95
| Professional | 26 | $39.81 | $39.81 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $45.71 / $56.23
| Professional | 26 | $25.70 | $45.71 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.80 / $18.62 / $28.18
| Professional | TC | $13.80 | $18.62 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $38.90 / $75.86
| Professional | | $19.50 | $38.90 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $21.38 / $51.29
| Professional | 26 | $14.13 | $21.38 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $4.27 / $11.48 / $28.84
| Professional | TC | $4.27 | $11.48 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $70.79
| Professional | | $67.61 | $67.61 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $56.23
| Professional | 26 | $53.70 | $53.70 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $54.95 / $95.50
| Facility | | $40.74 | $54.95 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $31.62
| Professional | | $31.62 | $31.62 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $28.18 / $53.70
| Professional | | $22.91 | $28.18 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $41.69 / $89.13
| Professional | | $23.44 | $41.69 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $30.20 / $64.57
| Professional | 26 | $17.38 | $30.20 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.89 / $13.80 / $34.67
| Professional | TC | $5.89 | $13.80 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $338.84
| Facility | | $338.84 | $338.84 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $190.55 / $190.55 / $190.55
| Facility | 26 | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $446.68
| Professional | | $338.84 | $338.84 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $263.03
| Professional | 26 | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $263.03
| Professional | TC | $263.03 | $263.03 | $263.03 |