- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $245.47 / $645.65
| Facility | | $57.54 | $245.47 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $12.02 / $33.88
| Facility | 26 | $7.94 | $12.02 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $134.90 / $537.03
| Facility | TC | $32.36 | $134.90 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $46.77 / $147.91
| Professional | | $10.23 | $46.77 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $16.60 / $50.12
| Professional | 26 | $8.32 | $16.60 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $21.88 / $93.33 / $223.87
| Professional | 50 | $21.88 | $93.33 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $33.11 / $67.61 / $67.61
| Professional | 52 | $33.11 | $67.61 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $42.66 / $97.72
| Professional | TC | $24.55 | $42.66 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $107.15 / $269.15
| Facility | | $33.11 | $107.15 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $10.00 / $10.00
| Facility | 26 | $10.00 | $10.00 | $10.00 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $27.54
| Facility | TC | $27.54 | $27.54 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $42.66 / $83.18
| Professional | | $30.20 | $42.66 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $12.02 / $20.89
| Professional | 26 | $7.94 | $12.02 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $45.71 / $63.10 / $120.23
| Professional | 50 | $45.71 | $63.10 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $31.62 / $63.10
| Professional | TC | $21.38 | $31.62 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $109.65 / $281.84
| Facility | | $54.95 | $109.65 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.19 / $11.75 / $32.36
| Facility | 26 | $2.19 | $11.75 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $7.41 / $38.90 / $120.23
| Facility | TC | $7.41 | $38.90 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $48.98 / $102.33
| Professional | | $30.20 | $48.98 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $12.88 / $24.55
| Professional | 26 | $7.59 | $12.88 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $37.15 / $52.48 / $56.23
| Professional | 50 | $37.15 | $52.48 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $37.15 / $81.28
| Professional | TC | $22.91 | $37.15 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $81.28 / $218.78
| Facility | | $22.91 | $81.28 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $47.86 / $151.36
| Professional | | $30.90 | $47.86 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $11.75 / $60.26
| Professional | 26 | $7.94 | $11.75 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $36.31 / $123.03
| Professional | TC | $22.91 | $36.31 | $123.03 |