- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $218.78 / $457.09
| Facility | | $112.20 | $218.78 | $457.09 |
- 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
- $190.55 / $257.04 / $524.81
| Facility | TC | $190.55 | $257.04 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $34.67 / $177.83
| Professional | | $17.38 | $34.67 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $14.45 / $47.86
| Professional | 26 | $7.08 | $14.45 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $158.49
| Professional | 50 | $47.86 | $47.86 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $34.67 / $169.82 / $338.84
| Professional | 52 | $34.67 | $169.82 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $26.92 / $125.89
| Professional | TC | $17.78 | $26.92 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $138.04 / $891.25
| Facility | | $31.62 | $138.04 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $36.31 / $66.07
| Professional | | $26.30 | $36.31 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $10.72 / $17.38
| Professional | 26 | $8.13 | $10.72 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $25.12 / $45.71
| Professional | TC | $18.20 | $25.12 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $32.36 / $60.26
| Professional | | $14.45 | $32.36 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $218.78 / $457.09
| Facility | | $151.36 | $218.78 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $199.53
| Facility | 26 | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $199.53
| Facility | TC | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $52.48 / $58.88
| Professional | | $43.65 | $52.48 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $13.18 / $18.62
| Professional | 26 | $11.22 | $13.18 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $37.15 / $42.66
| Professional | TC | $32.36 | $37.15 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $47.86 / $63.10
| Professional | | $29.51 | $47.86 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $12.59 / $19.05
| Professional | 26 | $7.76 | $12.59 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $35.48 / $41.69
| Professional | TC | $21.88 | $35.48 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $32.36 / $57.54
| Professional | | $11.48 | $32.36 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $30.90 / $51.29
| Professional | | $26.30 | $30.90 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $8.71 / $14.45
| Professional | 26 | $7.24 | $8.71 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $21.88 / $36.31
| Professional | TC | $17.78 | $21.88 | $36.31 |