- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $263.03 / $741.31
| Facility | | $165.96 | $263.03 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $7.08 / $7.08
| Facility | 26 | $7.08 | $7.08 | $7.08 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $104.71 / $245.47
| Facility | TC | $21.88 | $104.71 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $30.20 / $79.43
| Professional | | $7.59 | $30.20 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $13.80 / $25.12
| Professional | 26 | $7.24 | $13.80 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $33.11 / $173.78
| Professional | TC | $20.89 | $33.11 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $51.29 / $194.98
| Facility | | $29.51 | $51.29 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $43.65 / $47.86
| Professional | | $29.51 | $43.65 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $69.18 / $87.10
| Professional | | $56.23 | $69.18 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $17.38 / $21.88
| Professional | 26 | $13.80 | $17.38 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $52.48 / $66.07
| Professional | TC | $41.69 | $52.48 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $44.67 / $138.04
| Facility | | $33.88 | $44.67 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $38.90 / $186.21
| Professional | | $25.70 | $38.90 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $15.49 / $26.92
| Professional | 26 | $8.32 | $15.49 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $27.54 / $162.18
| Professional | TC | $17.38 | $27.54 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $61.66 / $63.10
| Professional | | $57.54 | $61.66 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $16.22 / $19.50
| Professional | 26 | $15.49 | $16.22 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $42.66 / $46.77
| Professional | TC | $41.69 | $42.66 | $46.77 |
- 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
- $17.38 / $17.38 / $17.38
| Professional | 26 | $17.38 | $17.38 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $41.69
| Professional | TC | $41.69 | $41.69 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $42.66 / $57.54
| Professional | | $32.36 | $42.66 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $13.18 / $14.79
| Professional | 26 | $9.55 | $13.18 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $30.20 / $41.69
| Professional | TC | $22.39 | $30.20 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $47.86 / $64.57
| Professional | | $28.84 | $47.86 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $13.80 / $20.89
| Professional | 26 | $8.13 | $13.80 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $33.88 / $47.86
| Professional | TC | $20.89 | $33.88 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $58.88 / $58.88
| Professional | | $50.12 | $58.88 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $15.49 / $15.49
| Professional | 26 | $13.18 | $15.49 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $43.65 / $43.65
| Professional | TC | $37.15 | $43.65 | $43.65 |