- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $95.50 / $281.84
| Facility | | $37.15 | $95.50 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $9.55 / $43.65
| Facility | 26 | $6.92 | $9.55 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $29.51 / $60.26
| Facility | TC | $20.42 | $29.51 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $33.88 / $81.28
| Professional | | $16.98 | $33.88 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $13.49 / $38.02
| Professional | 26 | $6.76 | $13.49 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $33.11 / $109.65 / $208.93
| Professional | 50 | $33.11 | $109.65 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $11.22 / $28.84 / $91.20
| Professional | 52 | $11.22 | $28.84 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $26.92 / $52.48
| Professional | TC | $19.95 | $26.92 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $32.36 / $58.88
| Professional | | $22.91 | $32.36 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.31 / $8.51 / $15.14
| Professional | 26 | $6.31 | $8.51 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $70.79
| Professional | 50 | $42.66 | $42.66 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.22 / $24.55 / $37.15
| Professional | TC | $16.22 | $24.55 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $32.36 / $66.07
| Professional | | $20.42 | $32.36 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $12.88 / $20.42
| Professional | 26 | $7.94 | $12.88 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $31.62 / $57.54
| Professional | TC | $20.42 | $31.62 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $60.26 / $112.20
| Facility | | $51.29 | $60.26 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $9.77 / $9.77
| Facility | 26 | $9.77 | $9.77 | $9.77 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $25.70
| Facility | TC | $25.70 | $25.70 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $36.31 / $66.07
| Professional | | $25.12 | $36.31 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $10.96 / $18.62
| Professional | 26 | $7.08 | $10.96 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $39.81
| Professional | 50 | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $26.92 / $50.12
| Professional | TC | $18.20 | $26.92 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $363.08
| Facility | | $218.78 | $218.78 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | 26 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $165.96
| Facility | TC | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $281.84 / $281.84
| Professional | | $218.78 | $281.84 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $64.57 / $64.57
| Professional | 26 | $61.66 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $218.78 / $218.78
| Professional | TC | $165.96 | $218.78 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $36.31 / $95.50
| Facility | | $10.72 | $36.31 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $34.67 / $61.66
| Professional | | $26.92 | $34.67 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $9.55 / $16.60
| Professional | 26 | $7.94 | $9.55 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $24.55 / $45.71
| Professional | TC | $18.62 | $24.55 | $45.71 |