- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $87.10 / $257.04
| Facility | | $33.11 | $87.10 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $10.47 / $13.49
| Facility | 26 | $8.91 | $10.47 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $28.84 / $109.65
| Facility | TC | $24.55 | $28.84 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $36.31 / $97.72
| Professional | | $11.75 | $36.31 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $10.72 / $29.51
| Professional | 26 | $6.03 | $10.72 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $23.99 / $91.20 / $309.03
| Professional | 50 | $23.99 | $91.20 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $10.96 / $25.12 / $45.71
| Professional | 52 | $10.96 | $25.12 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $25.70 / $47.86
| Professional | TC | $15.85 | $25.70 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $21.88 / $29.51
| Professional | | $18.62 | $21.88 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.50 / $7.94 / $11.48
| Professional | 26 | $5.50 | $7.94 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $32.36
| Professional | 50 | $32.36 | $32.36 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $95.50 / $181.97
| Facility | | $44.67 | $95.50 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $38.90 / $45.71
| Professional | | $33.11 | $38.90 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $10.47 / $13.49
| Professional | 26 | $8.51 | $10.47 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $29.51 / $33.11
| Professional | TC | $25.12 | $29.51 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $39.81 / $79.43
| Facility | | $29.51 | $39.81 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $22.91 / $39.81
| Facility | TC | $22.39 | $22.91 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $19.50 / $19.50
| Professional | 26 | $7.24 | $19.50 | $19.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $64.57 / $97.72
| Facility | | $43.65 | $64.57 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $30.20 / $57.54
| Professional | | $19.50 | $30.20 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.25 / $8.71 / $16.60
| Professional | 26 | $5.25 | $8.71 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.80 / $22.39 / $41.69
| Professional | TC | $13.80 | $22.39 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $131.83 / $218.78
| Facility | | $44.67 | $131.83 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $30.90 / $46.77
| Professional | | $22.39 | $30.90 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.61 / $8.71 / $12.88
| Professional | 26 | $6.61 | $8.71 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $22.39 / $33.88
| Professional | TC | $15.85 | $22.39 | $33.88 |