- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $104.71 / $524.81
| Facility | | $40.74 | $104.71 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $10.47 / $15.49
| Facility | 26 | $8.32 | $10.47 | $15.49 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $194.98 / $645.65
| Facility | TC | $25.12 | $194.98 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $33.11 / $91.20
| Professional | | $16.22 | $33.11 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $16.22 / $47.86
| Professional | 26 | $7.08 | $16.22 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $35.48 / $89.13 / $199.53
| Professional | 50 | $35.48 | $89.13 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $19.05 / $32.36 / $120.23
| Professional | 52 | $19.05 | $32.36 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $23.99 / $61.66
| Professional | TC | $16.98 | $23.99 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $102.33 / $162.18
| Facility | | $74.13 | $102.33 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $40.74 / $63.10
| Professional | | $28.84 | $40.74 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $10.47 / $15.85
| Professional | 26 | $7.59 | $10.47 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $33.11 / $43.65 / $57.54
| Professional | 50 | $33.11 | $43.65 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $30.90 / $47.86
| Professional | TC | $19.95 | $30.90 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $125.89 / $426.58
| Facility | | $56.23 | $125.89 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $16.22 / $16.22
| Facility | 26 | $16.22 | $16.22 | $16.22 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $42.66
| Facility | TC | $42.66 | $42.66 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $36.31 / $64.57
| Professional | | $23.99 | $36.31 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $10.47 / $18.20
| Professional | 26 | $7.08 | $10.47 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $25.12 / $45.71
| Professional | TC | $16.60 | $25.12 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $51.29 / $123.03
| Professional | | $39.81 | $51.29 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $12.59 / $37.15
| Professional | 26 | $11.48 | $12.59 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $38.90 / $87.10
| Professional | TC | $35.48 | $38.90 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $33.11 / $47.86
| Professional | | $30.20 | $33.11 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $8.13 / $12.59
| Professional | 26 | $7.94 | $8.13 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $24.55 / $35.48
| Professional | TC | $21.88 | $24.55 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $245.47 / $245.47
| Facility | | $42.66 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $43.65 / $72.44
| Professional | | $26.30 | $43.65 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $13.49 / $25.12
| Professional | 26 | $7.94 | $13.49 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $30.20 / $54.95
| Professional | TC | $18.62 | $30.20 | $54.95 |