- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $229.09 / $436.52
| Facility | | $70.79 | $229.09 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $10.23 / $25.12
| Facility | 26 | $6.92 | $10.23 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $31.62 / $602.56
| Facility | TC | $20.89 | $31.62 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $38.90 / $102.33
| Professional | | $16.60 | $38.90 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $14.13 / $40.74
| Professional | 26 | $6.76 | $14.13 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $46.77 / $91.20 / $177.83
| Professional | 50 | $46.77 | $91.20 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $22.91 / $33.88 / $66.07
| Professional | 52 | $22.91 | $33.88 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $30.20 / $66.07
| Professional | TC | $19.05 | $30.20 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $45.71 / $63.10
| Professional | | $20.89 | $45.71 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $12.88 / $19.95
| Professional | 26 | $8.32 | $12.88 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $67.61
| Professional | 50 | $63.10 | $63.10 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.62 / $25.70 / $30.20
| Professional | TC | $5.62 | $25.70 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $19.95 / $19.95
| Professional | | $19.95 | $19.95 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $17.78 / $23.44
| Professional | 26 | $12.02 | $17.78 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $37.15 / $61.66
| Professional | TC | $28.18 | $37.15 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $81.28 / $147.91
| Facility | | $37.15 | $81.28 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $43.65 / $81.28
| Professional | | $25.70 | $43.65 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $11.75 / $20.89
| Professional | 26 | $6.76 | $11.75 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $30.90 / $57.54
| Professional | TC | $18.62 | $30.90 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $42.66
| Professional | | $42.66 | $42.66 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $14.13 / $14.13
| Professional | 26 | $14.13 | $14.13 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $39.81 / $64.57
| Facility | | $28.18 | $39.81 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $354.81 / $426.58
| Facility | | $354.81 | $354.81 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $30.90 / $64.57
| Professional | | $8.51 | $30.90 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $35.48 / $67.61
| Facility | | $11.22 | $35.48 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $37.15 / $74.13
| Professional | | $26.30 | $37.15 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $10.23 / $22.91
| Professional | 26 | $7.41 | $10.23 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $26.92 / $54.95
| Professional | TC | $18.62 | $26.92 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $363.08
| Facility | | $208.93 | $208.93 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | 26 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $158.49
| Facility | TC | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $269.15
| Professional | | $208.93 | $208.93 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $70.79
| Professional | 26 | $70.79 | $70.79 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $208.93
| Professional | TC | $158.49 | $158.49 | $208.93 |