- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $234.42 / $549.54
| Facility | | $40.74 | $234.42 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $10.00 / $24.55
| Facility | 26 | $6.76 | $10.00 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $75.86 / $407.38
| Facility | TC | $21.38 | $75.86 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $32.36 / $91.20
| Professional | | $10.72 | $32.36 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $13.18 / $38.02
| Professional | 26 | $7.08 | $13.18 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $16.98 / $79.43 / $190.55
| Professional | 50 | $16.98 | $79.43 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $26.30 / $60.26
| Professional | TC | $16.98 | $26.30 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $74.13 / $269.15
| Facility | | $25.12 | $74.13 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $8.91 / $8.91
| Facility | 26 | $8.91 | $8.91 | $8.91 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $18.20 / $18.20
| Facility | TC | $18.20 | $18.20 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $33.11 / $61.66
| Professional | | $24.55 | $33.11 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $10.47 / $18.20
| Professional | 26 | $6.76 | $10.47 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $37.15 / $47.86 / $89.13
| Professional | 50 | $37.15 | $47.86 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $23.44 / $44.67
| Professional | TC | $16.98 | $23.44 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $83.18 / $263.03
| Facility | | $43.65 | $83.18 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.86 / $10.00 / $26.30
| Facility | 26 | $1.86 | $10.00 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.01 / $26.92 / $81.28
| Facility | TC | $5.01 | $26.92 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $37.15 / $75.86
| Professional | | $22.91 | $37.15 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.46 / $10.96 / $20.89
| Professional | 26 | $6.46 | $10.96 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $29.51 / $41.69 / $61.66
| Professional | 50 | $29.51 | $41.69 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.22 / $26.92 / $56.23
| Professional | TC | $16.22 | $26.92 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $81.28 / $218.78
| Facility | | $19.05 | $81.28 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $35.48 / $95.50
| Professional | | $23.99 | $35.48 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $10.47 / $52.48
| Professional | 26 | $6.92 | $10.47 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $25.12 / $93.33
| Professional | TC | $16.60 | $25.12 | $93.33 |