- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $309.03 / $549.54
| Facility | | $45.71 | $309.03 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $7.24 / $12.30
| Facility | 26 | $7.08 | $7.24 | $12.30 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $309.03 / $691.83
| Facility | TC | $36.31 | $309.03 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $28.18 / $61.66
| Professional | | $15.14 | $28.18 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.31 / $15.85 / $32.36
| Professional | 26 | $6.31 | $15.85 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $22.39 / $52.48 / $186.21
| Professional | 50 | $22.39 | $52.48 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $16.22 / $24.55 / $50.12
| Professional | 52 | $16.22 | $24.55 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $27.54 / $58.88
| Professional | TC | $16.98 | $27.54 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $25.70 / $40.74
| Facility | | $9.12 | $25.70 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $28.84 / $58.88
| Professional | | $9.77 | $28.84 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $66.07 / $181.97
| Facility | | $43.65 | $66.07 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.82 / $8.51 / $12.02
| Facility | 26 | $1.82 | $8.51 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $4.90 / $22.91 / $32.36
| Facility | TC | $4.90 | $22.91 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $37.15 / $131.83
| Professional | | $21.88 | $37.15 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.89 / $10.72 / $39.81
| Professional | 26 | $5.89 | $10.72 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.22 / $26.30 / $97.72
| Professional | TC | $16.22 | $26.30 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $354.81 / $467.74
| Facility | | $102.33 | $354.81 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $269.15 / $398.11
| Facility | TC | $97.72 | $269.15 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $74.13 / $75.86
| Professional | | $74.13 | $74.13 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $19.05 / $22.91
| Professional | 26 | $11.22 | $19.05 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $75.86
| Professional | TC | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $245.47
| Facility | | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $29.51 / $53.70
| Professional | | $19.95 | $29.51 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.62 / $8.91 / $15.85
| Professional | 26 | $5.62 | $8.91 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.45 / $20.42 / $37.15
| Professional | TC | $14.45 | $20.42 | $37.15 |