- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $114.82 / $676.08
| Facility | | $45.71 | $114.82 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $11.75 / $15.14
| Facility | 26 | $10.72 | $11.75 | $15.14 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $42.66 / $239.88
| Facility | TC | $28.18 | $42.66 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $34.67 / $138.04
| Professional | | $11.22 | $34.67 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $9.77 / $36.31
| Professional | 26 | $6.03 | $9.77 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $15.85 / $15.85 / $15.85
| Professional | 50 | $15.85 | $15.85 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $26.30 / $63.10
| Professional | TC | $16.98 | $26.30 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $18.62 / $22.39
| Professional | | $18.20 | $18.62 | $22.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $316.23 / $512.86
| Facility | | $89.13 | $316.23 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $22.39 / $56.23
| Professional | | $6.03 | $22.39 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $22.39 / $22.39
| Facility | | $22.39 | $22.39 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $43.65 / $63.10
| Professional | | $26.92 | $43.65 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $10.96 / $15.85
| Professional | 26 | $6.92 | $10.96 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $31.62 / $46.77
| Professional | TC | $19.95 | $31.62 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $32.36 / $37.15
| Professional | | $14.79 | $32.36 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $43.65 / $67.61
| Facility | | $31.62 | $43.65 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $51.29 / $74.13
| Professional | | $28.18 | $51.29 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $10.96 / $15.85
| Professional | 26 | $7.24 | $10.96 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $31.62 / $45.71
| Professional | TC | $21.38 | $31.62 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $169.82 / $380.19
| Facility | | $10.72 | $169.82 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $34.67 / $77.62
| Professional | | $31.62 | $34.67 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $9.12 / $29.51
| Professional | 26 | $8.32 | $9.12 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $25.70 / $51.29
| Professional | TC | $22.39 | $25.70 | $51.29 |