- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $346.74 / $851.14
| Facility | | $93.33 | $346.74 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $35.48 / $72.44
| Facility | 26 | $26.92 | $35.48 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $354.81 / $691.83
| Facility | TC | $218.78 | $354.81 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $42.66 / $147.91
| Professional | | $10.96 | $42.66 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $16.22 / $50.12
| Professional | 26 | $7.41 | $16.22 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $41.69 / $50.12 / $199.53
| Professional | 50 | $41.69 | $50.12 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $50.12 / $147.91
| Professional | TC | $19.95 | $50.12 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $389.05
| Facility | | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $56.23 / $107.15
| Professional | | $32.36 | $56.23 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $14.13 / $28.84
| Professional | 26 | $9.55 | $14.13 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $40.74 / $77.62
| Professional | TC | $22.39 | $40.74 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $89.13 / $794.33
| Facility | | $33.11 | $89.13 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $35.48 / $72.44
| Facility | 26 | $26.92 | $35.48 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $354.81 / $794.33
| Facility | TC | $79.43 | $354.81 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $91.20 / $162.18
| Professional | | $28.84 | $91.20 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $25.70 / $60.26
| Professional | 26 | $8.51 | $25.70 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $41.69 / $194.98 / $354.81
| Professional | 50 | $41.69 | $194.98 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $74.13 / $147.91
| Professional | TC | $28.18 | $74.13 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $151.36 / $213.80
| Professional | | $141.25 | $151.36 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $33.88 / $56.23
| Professional | 26 | $30.90 | $33.88 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $117.49 / $162.18
| Professional | TC | $81.28 | $117.49 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $48.98 / $87.10
| Facility | | $30.20 | $48.98 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $89.13 / $107.15
| Professional | | $33.88 | $89.13 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $11.75 / $30.90
| Professional | 26 | $7.08 | $11.75 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $33.11 / $77.62
| Professional | TC | $22.91 | $33.11 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $83.18 / $177.83
| Professional | | $42.66 | $83.18 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $24.55 / $64.57
| Professional | 26 | $9.55 | $24.55 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $58.88 / $125.89
| Professional | TC | $31.62 | $58.88 | $125.89 |