- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $173.78 / $588.84
| Facility | | $45.71 | $173.78 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $12.59 / $40.74
| Facility | 26 | $7.94 | $12.59 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $104.71 / $630.96
| Facility | TC | $22.39 | $104.71 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $38.02 / $102.33
| Professional | | $9.12 | $38.02 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $12.59 / $43.65
| Professional | 26 | $7.94 | $12.59 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $30.20 / $97.72 / $199.53
| Professional | 50 | $30.20 | $97.72 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $33.88 / $85.11
| Professional | TC | $19.95 | $33.88 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $34.67 / $58.88
| Professional | | $23.99 | $34.67 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $12.02 / $16.98
| Professional | 26 | $7.41 | $12.02 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $42.66 / $67.61 / $93.33
| Professional | 50 | $42.66 | $67.61 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $33.11 / $47.86
| Professional | TC | $17.78 | $33.11 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $50.12 / $87.10
| Facility | | $26.30 | $50.12 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $38.02 / $69.18
| Professional | | $28.84 | $38.02 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $12.02 / $21.38
| Professional | 26 | $8.91 | $12.02 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $42.66 / $58.88 / $104.71
| Professional | 50 | $42.66 | $58.88 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $26.92 / $48.98
| Professional | TC | $19.50 | $26.92 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $33.11 / $50.12
| Facility | | $12.30 | $33.11 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $27.54 / $42.66
| Professional | | $9.33 | $27.54 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $57.54 / $158.49
| Facility | | $38.90 | $57.54 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $43.65 / $83.18
| Professional | | $27.54 | $43.65 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $13.18 / $23.44
| Professional | 26 | $8.13 | $13.18 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $30.20 / $60.26
| Professional | TC | $19.50 | $30.20 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $46.77 / $104.71
| Professional | | $36.31 | $46.77 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $12.30 / $32.36
| Professional | 26 | $9.12 | $12.30 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $35.48 / $85.11
| Professional | TC | $26.92 | $35.48 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,288.25 / $2,818.38
| Facility | | $1,288.25 | $1,288.25 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $33.88 / $60.26
| Professional | | $9.55 | $33.88 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $186.21 / $218.78
| Facility | | $26.30 | $186.21 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $37.15 / $72.44
| Professional | | $29.51 | $37.15 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $10.96 / $20.89
| Professional | 26 | $8.32 | $10.96 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $26.30 / $51.29
| Professional | TC | $20.42 | $26.30 | $51.29 |