- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $131.83 / $323.59
| Facility | | $33.88 | $131.83 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $10.47 / $12.88
| Facility | 26 | $10.00 | $10.47 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $24.55 / $181.97
| Facility | TC | $19.95 | $24.55 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $30.90 / $83.18
| Professional | | $11.48 | $30.90 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.31 / $10.96 / $34.67
| Professional | 26 | $6.31 | $10.96 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $33.11 / $134.90 / $144.54
| Professional | 50 | $33.11 | $134.90 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $22.91 / $44.67
| Professional | TC | $15.14 | $22.91 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $22.39 / $28.84
| Professional | | $19.50 | $22.39 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $7.59 / $12.59
| Professional | 26 | $6.76 | $7.59 | $12.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $104.71
| Facility | | $75.86 | $75.86 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $32.36 / $41.69
| Professional | | $28.18 | $32.36 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $10.47 / $13.49
| Professional | 26 | $9.12 | $10.47 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $21.88 / $28.18
| Professional | TC | $19.50 | $21.88 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $26.30 / $45.71
| Facility | | $9.77 | $26.30 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $25.12 / $43.65
| Professional | | $8.51 | $25.12 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $52.48 / $162.18
| Facility | | $28.18 | $52.48 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.86 / $8.71 / $12.59
| Facility | 26 | $1.86 | $8.71 | $12.59 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.01 / $23.44 / $33.88
| Facility | TC | $5.01 | $23.44 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $34.67 / $54.95
| Professional | | $23.99 | $34.67 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $10.47 / $16.22
| Professional | 26 | $7.08 | $10.47 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $23.44 / $37.15
| Professional | TC | $17.38 | $23.44 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $44.67 / $54.95
| Professional | | $37.15 | $44.67 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $14.13 / $16.60
| Professional | 26 | $10.00 | $14.13 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $24.55 / $42.66
| Professional | TC | $17.38 | $24.55 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $141.25 / $251.19
| Facility | | $89.13 | $141.25 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $30.90 / $57.54
| Professional | | $25.70 | $30.90 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $9.77 / $17.38
| Professional | 26 | $7.59 | $9.77 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $20.89 / $40.74
| Professional | TC | $17.78 | $20.89 | $40.74 |