- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $263.03 / $645.65
| Facility | | $36.31 | $263.03 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.50 / $6.92 / $25.12
| Facility | 26 | $5.50 | $6.92 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.45 / $81.28 / $263.03
| Facility | TC | $14.45 | $81.28 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $30.90 / $91.20
| Professional | | $16.22 | $30.90 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $13.80 / $40.74
| Professional | 26 | $6.03 | $13.80 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $18.62 / $79.43 / $177.83
| Professional | 50 | $18.62 | $79.43 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $10.72 / $21.38 / $58.88
| Professional | 52 | $10.72 | $21.38 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.79 / $22.91 / $53.70
| Professional | TC | $14.79 | $22.91 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $24.55 / $45.71
| Professional | | $19.50 | $24.55 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.89 / $7.59 / $14.13
| Professional | 26 | $5.89 | $7.59 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $29.51 / $36.31 / $60.26
| Professional | 50 | $29.51 | $36.31 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $6.03 / $6.03 / $10.00
| Professional | 52 | $6.03 | $6.03 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $21.38 / $40.74
| Professional | TC | $16.98 | $21.38 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $33.11 / $109.65
| Facility | | $15.85 | $33.11 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $21.88 / $25.12
| Professional | | $18.20 | $21.88 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $104.71 / $213.80
| Facility | | $48.98 | $104.71 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.95 / $9.12 / $15.85
| Facility | 26 | $1.95 | $9.12 | $15.85 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.37 / $25.12 / $36.31
| Facility | TC | $5.37 | $25.12 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $29.51 / $61.66
| Professional | | $19.95 | $29.51 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.75 / $9.12 / $18.20
| Professional | 26 | $5.75 | $9.12 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.45 / $21.38 / $48.98
| Professional | TC | $14.45 | $21.38 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $50.12 / $109.65
| Facility | | $18.62 | $50.12 | $109.65 |
- 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
- $18.62 / $18.62 / $18.62
| Facility | TC | $18.62 | $18.62 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $24.55 / $39.81
| Professional | | $20.42 | $24.55 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.62 / $7.76 / $11.75
| Professional | 26 | $5.62 | $7.76 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.80 / $17.38 / $27.54
| Professional | TC | $13.80 | $17.38 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $19.95 / $33.11
| Professional | | $5.01 | $19.95 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $87.10 / $239.88
| Facility | | $11.48 | $87.10 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $27.54 / $58.88
| Professional | | $20.89 | $27.54 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.31 / $8.13 / $18.20
| Professional | 26 | $6.31 | $8.13 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.45 / $19.50 / $42.66
| Professional | TC | $14.45 | $19.50 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $16.98 / $32.36
| Professional | | $16.98 | $16.98 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.37 / $4.37 / $8.32
| Professional | 26 | $4.37 | $4.37 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.88 / $12.88 / $23.99
| Professional | TC | $12.88 | $12.88 | $23.99 |