- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $141.25 / $331.13
| Facility | | $43.65 | $141.25 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $13.80 / $17.78
| Facility | 26 | $12.59 | $13.80 | $17.78 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $34.67 / $120.23
| Facility | TC | $30.20 | $34.67 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $48.98 / $85.11
| Professional | | $30.90 | $48.98 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $13.80 / $30.90
| Professional | 26 | $8.71 | $13.80 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $50.12 / $186.21 / $204.17
| Professional | 50 | $50.12 | $186.21 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $17.78 / $17.78 / $17.78
| Professional | 52 | $17.78 | $17.78 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $30.90 / $56.23
| Professional | TC | $21.88 | $30.90 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $28.18 / $37.15
| Professional | | $23.99 | $28.18 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $10.23 / $15.49
| Professional | 26 | $7.41 | $10.23 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $31.62
| Professional | TC | $31.62 | $31.62 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $125.89 / $269.15
| Facility | | $52.48 | $125.89 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $50.12 / $61.66
| Professional | | $42.66 | $50.12 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $14.13 / $18.62
| Professional | 26 | $11.75 | $14.13 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $36.31 / $42.66
| Professional | TC | $30.90 | $36.31 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $40.74 / $112.20
| Facility | | $38.02 | $40.74 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $29.51 / $39.81
| Facility | TC | $28.18 | $29.51 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $26.30 / $26.30
| Professional | 26 | $10.00 | $26.30 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $95.50 / $128.82
| Facility | | $58.88 | $95.50 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $38.02 / $74.13
| Professional | | $26.30 | $38.02 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $11.75 / $21.88
| Professional | 26 | $7.41 | $11.75 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $28.18 / $56.23
| Professional | TC | $18.20 | $28.18 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $162.18 / $263.03
| Facility | | $75.86 | $162.18 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $40.74 / $61.66
| Professional | | $28.84 | $40.74 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $11.48 / $17.78
| Professional | 26 | $9.12 | $11.48 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $27.54 / $41.69
| Professional | TC | $19.95 | $27.54 | $41.69 |