- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $190.55 / $389.05
| Facility | | $43.65 | $190.55 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $10.72 / $10.72
| Facility | 26 | $7.59 | $10.72 | $10.72 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $32.36 / $331.13
| Facility | TC | $22.91 | $32.36 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $30.90 / $87.10
| Professional | | $7.94 | $30.90 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $15.14 / $40.74
| Professional | 26 | $7.08 | $15.14 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $17.78 / $79.43 / $199.53
| Professional | 50 | $17.78 | $79.43 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $28.18 / $33.11 / $251.19
| Professional | 52 | $28.18 | $33.11 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $32.36 / $74.13
| Professional | TC | $19.95 | $32.36 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $28.18 / $42.66
| Professional | | $21.88 | $28.18 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.89 / $8.51 / $10.47
| Professional | 26 | $5.89 | $8.51 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $33.88 / $45.71 / $69.18
| Professional | 50 | $33.88 | $45.71 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $23.44 / $30.90
| Professional | TC | $17.38 | $23.44 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $93.33 / $125.89
| Facility | | $79.43 | $93.33 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $42.66 / $54.95
| Professional | | $30.20 | $42.66 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $12.30 / $15.85
| Professional | 26 | $8.51 | $12.30 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $30.20 / $38.90
| Professional | TC | $21.38 | $30.20 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $52.48 / $213.80
| Facility | | $38.90 | $52.48 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $9.33 / $9.55
| Facility | 26 | $9.33 | $9.33 | $9.55 |
- 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
- $22.91 / $35.48 / $70.79
| Professional | | $22.91 | $35.48 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $11.48 / $20.89
| Professional | 26 | $6.92 | $11.48 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $26.30 / $63.10
| Professional | TC | $17.38 | $26.30 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $128.82 / $158.49
| Facility | | $18.62 | $128.82 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $32.36 / $60.26
| Professional | | $22.39 | $32.36 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.61 / $8.71 / $51.29
| Professional | 26 | $6.61 | $8.71 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $23.99 / $44.67
| Professional | TC | $15.85 | $23.99 | $44.67 |