- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $354.81 / $660.69
| Facility | | $79.43 | $354.81 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $8.51 / $14.79
| Facility | 26 | $8.13 | $8.51 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $39.81 / $371.54
| Facility | TC | $25.70 | $39.81 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $39.81 / $128.82
| Professional | | $10.96 | $39.81 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $13.80 / $42.66
| Professional | 26 | $7.59 | $13.80 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $42.66 / $107.15 / $199.53
| Professional | 50 | $42.66 | $107.15 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $37.15 / $83.18
| Professional | TC | $21.88 | $37.15 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $33.11 / $43.65
| Professional | | $24.55 | $33.11 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $9.12 / $10.96
| Professional | 26 | $6.17 | $9.12 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $41.69
| Professional | 50 | $41.69 | $41.69 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $27.54 / $33.11
| Professional | TC | $19.95 | $27.54 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $30.90 / $52.48
| Professional | | $27.54 | $30.90 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $9.77 / $16.60
| Professional | 26 | $8.91 | $9.77 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $41.69 / $45.71 / $79.43
| Professional | 50 | $41.69 | $45.71 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $19.95 / $38.02
| Professional | TC | $18.62 | $19.95 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $31.62 / $45.71
| Facility | | $8.51 | $31.62 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $26.30 / $42.66
| Professional | | $8.51 | $26.30 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $56.23 / $97.72
| Facility | | $36.31 | $56.23 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.04 / $9.55 / $13.49
| Facility | 26 | $2.04 | $9.55 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.46 / $30.20 / $43.65
| Facility | TC | $6.46 | $30.20 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $50.12 / $169.82
| Professional | | $28.18 | $50.12 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $13.18 / $41.69
| Professional | 26 | $7.76 | $13.18 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $37.15 / $131.83
| Professional | TC | $20.89 | $37.15 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $32.36 / $33.11
| Professional | | $7.59 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $25.12 / $66.07
| Facility | | $7.59 | $25.12 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $33.11 / $60.26
| Professional | | $26.92 | $33.11 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $9.33 / $18.20
| Professional | 26 | $7.76 | $9.33 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $50.12
| Professional | 50 | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $23.44 / $43.65
| Professional | TC | $18.62 | $23.44 | $43.65 |