- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $380.19 / $794.33
| Facility | | $67.61 | $380.19 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $9.77 / $14.13
| Facility | 26 | $7.59 | $9.77 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $39.81 / $426.58
| Facility | TC | $20.42 | $39.81 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $37.15 / $112.20
| Professional | | $10.23 | $37.15 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $13.18 / $53.70
| Professional | 26 | $7.94 | $13.18 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $32.36 / $67.61 / $407.38
| Professional | 50 | $32.36 | $67.61 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $35.48 / $89.13
| Professional | TC | $19.95 | $35.48 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $26.92 / $33.88
| Professional | | $21.38 | $26.92 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $7.08 / $8.71
| Professional | 26 | $6.76 | $7.08 | $8.71 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $38.02 / $50.12 / $70.79
| Professional | 50 | $38.02 | $50.12 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $20.89 / $34.67
| Professional | TC | $19.95 | $20.89 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $128.82 / $263.03
| Facility | | $79.43 | $128.82 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $63.10 / $426.58
| Facility | TC | $46.77 | $63.10 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $38.90 / $64.57
| Professional | | $33.88 | $38.90 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $18.20 / $26.92
| Professional | 26 | $9.12 | $18.20 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $25.70 / $37.15
| Professional | TC | $17.38 | $25.70 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $234.42 / $446.68
| Facility | | $120.23 | $234.42 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $38.90 / $60.26
| Professional | | $28.18 | $38.90 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $12.02 / $19.05
| Professional | 26 | $8.91 | $12.02 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $25.70 / $41.69
| Professional | TC | $19.50 | $25.70 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $58.88
| Professional | | $58.88 | $58.88 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $19.50 / $19.50
| Professional | 26 | $19.50 | $19.50 | $19.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $41.69 / $74.13
| Facility | | $28.18 | $41.69 | $74.13 |
- 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
- $52.48 / $81.28 / $363.08
| Facility | | $52.48 | $81.28 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $37.15 / $64.57
| Professional | | $25.70 | $37.15 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $10.72 / $19.50
| Professional | 26 | $8.51 | $10.72 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $25.12 / $45.71
| Professional | TC | $17.38 | $25.12 | $45.71 |