- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $194.98 / $251.19
| Facility | | $46.77 | $194.98 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $389.05
| Facility | TC | $229.09 | $229.09 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $36.31 / $141.25
| Professional | | $13.18 | $36.31 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $13.49 / $37.15
| Professional | 26 | $7.24 | $13.49 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $15.85 / $66.07 / $66.07
| Professional | 50 | $15.85 | $66.07 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $12.59 / $16.22 / $18.20
| Professional | 52 | $12.59 | $16.22 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $31.62 / $56.23
| Professional | TC | $19.95 | $31.62 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $66,069.34 / $95,499.26
| Facility | | $102.33 | $66,069.34 | $95,499.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $51.29 / $51.29
| Professional | | $12.02 | $51.29 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $47.86 / $134.90
| Facility | | $35.48 | $47.86 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $12.02 / $14.79
| Facility | 26 | $12.02 | $12.02 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $47.86
| Facility | TC | $38.90 | $38.90 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $44.67 / $75.86
| Professional | | $26.30 | $44.67 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $12.02 / $20.42
| Professional | 26 | $6.76 | $12.02 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $30.20 / $58.88
| Professional | TC | $18.62 | $30.20 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $56.23 / $85.11
| Facility | | $48.98 | $56.23 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $56.23 / $85.11
| Professional | | $48.98 | $56.23 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $44.67 / $74.13
| Facility | | $27.54 | $44.67 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $12.02 / $14.79
| Facility | 26 | $12.02 | $12.02 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $47.86
| Facility | TC | $38.90 | $38.90 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $72.44 / $87.10
| Professional | | $41.69 | $72.44 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $12.02 / $17.78
| Professional | 26 | $7.59 | $12.02 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $35.48 / $56.23
| Professional | TC | $23.44 | $35.48 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $43.65 / $43.65
| Facility | | $43.65 | $43.65 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $32.36 / $61.66
| Professional | | $27.54 | $32.36 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $8.71 / $66.07
| Professional | 26 | $8.13 | $8.71 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $23.44 / $45.71
| Professional | TC | $19.50 | $23.44 | $45.71 |