- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $234.42 / $549.54
| Facility | | $43.65 | $234.42 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $10.96 / $10.96
| Facility | 26 | $7.59 | $10.96 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $37.15 / $676.08
| Facility | TC | $33.11 | $37.15 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $34.67 / $102.33
| Professional | | $8.13 | $34.67 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $14.79 / $44.67
| Professional | 26 | $7.08 | $14.79 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $17.78 / $77.62 / $199.53
| Professional | 50 | $17.78 | $77.62 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $29.51 / $95.50 / $95.50
| Professional | 52 | $29.51 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $33.88 / $79.43
| Professional | TC | $20.42 | $33.88 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $26.30 / $39.81
| Professional | | $21.38 | $26.30 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $9.12 / $13.80
| Professional | 26 | $6.03 | $9.12 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $33.11 / $40.74 / $63.10
| Professional | 50 | $33.11 | $40.74 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.22 / $19.05 / $30.90
| Professional | TC | $16.22 | $19.05 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $93.33 / $125.89
| Facility | | $79.43 | $93.33 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $44.67 / $57.54
| Professional | | $30.90 | $44.67 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $13.80 / $17.38
| Professional | 26 | $9.55 | $13.80 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $30.90 / $39.81
| Professional | TC | $21.38 | $30.90 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $52.48 / $213.80
| Facility | | $38.90 | $52.48 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $9.33 / $9.55
| Facility | 26 | $9.33 | $9.33 | $9.55 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $20.42 / $20.89
| Facility | TC | $20.42 | $20.42 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $34.67 / $70.79
| Professional | | $23.44 | $34.67 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $10.72 / $20.89
| Professional | 26 | $6.92 | $10.72 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $27.54 / $61.66
| Professional | TC | $18.20 | $27.54 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $128.82 / $158.49
| Facility | | $19.50 | $128.82 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $31.62 / $58.88
| Professional | | $22.39 | $31.62 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.61 / $8.51 / $21.88
| Professional | 26 | $6.61 | $8.51 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $23.44 / $45.71
| Professional | TC | $15.85 | $23.44 | $45.71 |