- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $309.03 / $537.03
| Facility | | $138.04 | $309.03 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $7.94 / $7.94
| Facility | 26 | $7.94 | $7.94 | $7.94 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $245.47 / $407.38
| Facility | TC | $30.20 | $245.47 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $37.15 / $104.71
| Professional | | $8.13 | $37.15 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $9.33 / $39.81
| Professional | 26 | $7.94 | $9.33 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $39.81
| Professional | 50 | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $60.26
| Professional | 52 | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $42.66 / $208.93
| Professional | TC | $26.92 | $42.66 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $107.15 / $194.98
| Facility | | $36.31 | $107.15 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $60.26 / $66.07
| Professional | | $36.31 | $60.26 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $87.10 / $107.15
| Professional | | $69.18 | $87.10 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $19.05 / $23.99
| Professional | 26 | $15.14 | $19.05 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $67.61 / $85.11
| Professional | TC | $53.70 | $67.61 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $56.23 / $269.15
| Facility | | $40.74 | $56.23 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $43.65 / $89.13
| Professional | | $30.20 | $43.65 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $16.22 / $21.88
| Professional | 26 | $9.55 | $16.22 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $36.31 / $181.97
| Professional | TC | $22.91 | $36.31 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $74.13 / $77.62
| Professional | | $70.79 | $74.13 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $17.78 / $20.42
| Professional | 26 | $16.98 | $17.78 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $54.95 / $60.26
| Professional | TC | $53.70 | $54.95 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $70.79
| Professional | | $70.79 | $70.79 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $18.20 / $18.20
| Professional | 26 | $18.20 | $18.20 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $53.70
| Professional | TC | $53.70 | $53.70 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $52.48 / $70.79
| Professional | | $38.02 | $52.48 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $14.13 / $16.22
| Professional | 26 | $10.47 | $14.13 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $38.90 / $54.95
| Professional | TC | $28.84 | $38.90 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $57.54 / $79.43
| Professional | | $34.67 | $57.54 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $14.79 / $22.91
| Professional | 26 | $8.91 | $14.79 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $39.81 / $61.66
| Professional | TC | $25.12 | $39.81 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $72.44 / $72.44
| Professional | | $61.66 | $72.44 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $16.98 / $16.98
| Professional | 26 | $14.45 | $16.98 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $56.23 / $56.23
| Professional | TC | $47.86 | $56.23 | $56.23 |