- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $239.88 / $436.52
| Facility | | $97.72 | $239.88 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $10.72 / $15.49
| Facility | 26 | $7.76 | $10.72 | $15.49 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $263.03 / $489.78
| Facility | TC | $39.81 | $263.03 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $45.71 / $158.49
| Professional | | $9.55 | $45.71 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $17.38 / $43.65
| Professional | 26 | $8.51 | $17.38 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $20.89 / $85.11 / $169.82
| Professional | 50 | $20.89 | $85.11 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $46.77 / $112.20
| Professional | TC | $25.70 | $46.77 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $38.90 / $46.77
| Professional | | $9.55 | $38.90 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $8.71 / $12.88
| Professional | 26 | $8.51 | $8.71 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $33.11 / $46.77
| Professional | TC | $30.90 | $33.11 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $63.10
| Facility | | $38.90 | $38.90 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $14.79 / $14.79
| Facility | 26 | $14.79 | $14.79 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $48.98 / $48.98
| Facility | TC | $48.98 | $48.98 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $41.69 / $77.62
| Professional | | $29.51 | $41.69 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $10.47 / $19.95
| Professional | 26 | $6.92 | $10.47 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $30.90 / $61.66
| Professional | TC | $22.39 | $30.90 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $50.12 / $67.61
| Professional | | $42.66 | $50.12 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $10.72 / $14.79
| Professional | 26 | $9.55 | $10.72 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $38.90 / $53.70
| Professional | TC | $33.11 | $38.90 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $19.50 / $38.02
| Facility | | $6.92 | $19.50 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $42.66 / $87.10
| Professional | | $28.18 | $42.66 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $10.72 / $20.89
| Professional | 26 | $7.24 | $10.72 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $30.90 / $66.07
| Professional | TC | $21.38 | $30.90 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $48.98 / $67.61
| Professional | | $28.84 | $48.98 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $10.23 / $14.13
| Professional | 26 | $6.17 | $10.23 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $38.90 / $53.70
| Professional | TC | $22.39 | $38.90 | $53.70 |