- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $208.93 / $457.09
| Facility | | $45.71 | $208.93 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $407.38
| Facility | TC | $104.71 | $104.71 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $33.11 / $107.15
| Professional | | $14.45 | $33.11 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $14.45 / $40.74
| Professional | 26 | $7.24 | $14.45 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $117.49
| Professional | 50 | $79.43 | $79.43 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $29.51 / $53.70
| Professional | TC | $19.95 | $29.51 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $66,069.34 / $95,499.26
| Facility | | $87.10 | $66,069.34 | $95,499.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $12.59 / $46.77
| Professional | | $12.59 | $12.59 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $41.69 / $114.82
| Facility | | $30.20 | $41.69 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $12.59 / $15.49
| Facility | 26 | $12.59 | $12.59 | $15.49 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $33.88 / $41.69
| Facility | TC | $33.88 | $33.88 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $44.67 / $69.18
| Professional | | $24.55 | $44.67 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $12.59 / $19.50
| Professional | 26 | $6.76 | $12.59 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $30.90 / $50.12
| Professional | TC | $18.20 | $30.90 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $51.29 / $75.86
| Facility | | $45.71 | $51.29 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $51.29 / $75.86
| Professional | | $45.71 | $51.29 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $42.66 / $66.07
| Facility | | $26.92 | $42.66 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $12.59 / $15.49
| Facility | 26 | $12.59 | $12.59 | $15.49 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $33.88 / $41.69
| Facility | TC | $33.88 | $33.88 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $64.57 / $77.62
| Professional | | $36.31 | $64.57 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $12.59 / $18.20
| Professional | 26 | $7.76 | $12.59 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $31.62 / $48.98
| Professional | TC | $20.42 | $31.62 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $39.81
| Facility | | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $28.84 / $58.88
| Professional | | $26.92 | $28.84 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $8.71 / $66.07
| Professional | 26 | $7.76 | $8.71 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $20.42 / $42.66
| Professional | TC | $19.05 | $20.42 | $42.66 |