- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $134.90 / $257.04
| Facility | | $38.02 | $134.90 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $8.32 / $9.77
| Facility | 26 | $6.92 | $8.32 | $9.77 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $109.65 / $389.05
| Facility | TC | $20.89 | $109.65 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $34.67 / $134.90
| Professional | | $14.79 | $34.67 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $16.98 / $40.74
| Professional | 26 | $7.08 | $16.98 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $16.60 / $56.23 / $123.03
| Professional | 50 | $16.60 | $56.23 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $26.30 / $34.67 / $338.84
| Professional | 52 | $26.30 | $34.67 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $30.90 / $89.13
| Professional | TC | $18.20 | $30.90 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $31.62 / $36.31
| Professional | | $10.72 | $31.62 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $7.76 / $8.51
| Professional | 26 | $7.59 | $7.76 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $24.55 / $28.18
| Professional | TC | $21.38 | $24.55 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $33.88 / $48.98
| Facility | | $33.88 | $33.88 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $13.18 / $13.18
| Facility | 26 | $13.18 | $13.18 | $13.18 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $36.31
| Facility | TC | $36.31 | $36.31 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $31.62 / $60.26
| Professional | | $22.91 | $31.62 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $9.12 / $16.98
| Professional | 26 | $6.17 | $9.12 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $23.44 / $45.71
| Professional | TC | $16.60 | $23.44 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $37.15 / $50.12
| Professional | | $31.62 | $37.15 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $9.12 / $12.59
| Professional | 26 | $8.32 | $9.12 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $27.54 / $38.02
| Professional | TC | $23.44 | $27.54 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $16.22 / $28.84
| Facility | | $5.75 | $16.22 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $31.62 / $67.61
| Professional | | $21.88 | $31.62 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.31 / $8.91 / $17.78
| Professional | 26 | $6.31 | $8.91 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $22.91 / $48.98
| Professional | TC | $15.85 | $22.91 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $36.31 / $51.29
| Professional | | $21.38 | $36.31 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.25 / $8.71 / $12.30
| Professional | 26 | $5.25 | $8.71 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $27.54 / $38.90
| Professional | TC | $15.85 | $27.54 | $38.90 |