- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $165.96 / $363.08
| Facility | | $38.90 | $165.96 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $8.32 / $9.77
| Facility | 26 | $6.92 | $8.32 | $9.77 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $112.20 / $363.08
| Facility | TC | $22.39 | $112.20 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $33.88 / $114.82
| Professional | | $11.48 | $33.88 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $13.80 / $35.48
| Professional | 26 | $7.08 | $13.80 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $33.11 / $79.43 / $131.83
| Professional | 50 | $33.11 | $79.43 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $12.88 / $22.91 / $33.11
| Professional | 52 | $12.88 | $22.91 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $29.51 / $56.23
| Professional | TC | $19.05 | $29.51 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $32.36 / $36.31
| Professional | | $7.41 | $32.36 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $8.13 / $9.33
| Professional | 26 | $6.92 | $8.13 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $25.12 / $29.51
| Professional | TC | $22.91 | $25.12 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $33.88 / $50.12
| Facility | | $33.88 | $33.88 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $12.59 / $12.59
| Facility | 26 | $12.59 | $12.59 | $12.59 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.02 / $38.02 / $38.02
| Facility | TC | $38.02 | $38.02 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $33.11 / $58.88
| Professional | | $24.55 | $33.11 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.89 / $9.12 / $16.98
| Professional | 26 | $5.89 | $9.12 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $24.55 / $47.86
| Professional | TC | $17.78 | $24.55 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $38.02 / $51.29
| Professional | | $33.11 | $38.02 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $9.12 / $12.59
| Professional | 26 | $8.32 | $9.12 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $28.84 / $39.81
| Professional | TC | $24.55 | $28.84 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $16.22 / $30.20
| Facility | | $5.75 | $16.22 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $33.88 / $70.79
| Professional | | $22.91 | $33.88 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.31 / $9.12 / $17.78
| Professional | 26 | $6.31 | $9.12 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $24.55 / $51.29
| Professional | TC | $16.60 | $24.55 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $37.15 / $53.70
| Professional | | $23.44 | $37.15 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.50 / $8.71 / $12.30
| Professional | 26 | $5.50 | $8.71 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $28.84 / $41.69
| Professional | TC | $18.20 | $28.84 | $41.69 |