- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $104.71 / $346.74
| Facility | | $52.48 | $104.71 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $48.98 / $67.61
| Facility | 26 | $33.88 | $48.98 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $70.79 / $204.17
| Professional | | $40.74 | $70.79 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $33.88 / $75.86
| Professional | 26 | $25.12 | $33.88 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $70.79 / $95.50 / $95.50
| Professional | 50 | $70.79 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.13 / $19.05 / $36.31
| Professional | TC | $14.13 | $19.05 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $23.44 / $23.44
| Professional | 26 | $23.44 | $23.44 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $457.09 / $707.95
| Facility | | $346.74 | $457.09 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $138.04
| Professional | | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $134.90 / $239.88
| Facility | | $53.70 | $134.90 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $79.43 / $162.18
| Professional | | $39.81 | $79.43 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $45.71 / $83.18
| Professional | 26 | $25.70 | $45.71 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.79 / $33.88 / $89.13
| Professional | TC | $14.79 | $33.88 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $67.61 / $199.53
| Facility | | $46.77 | $67.61 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $199.53 / $199.53
| Facility | 26 | $70.79 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $97.72 / $660.69
| Professional | | $53.70 | $97.72 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $54.95 / $338.84
| Professional | 26 | $31.62 | $54.95 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $47.86 / $407.38
| Professional | TC | $21.38 | $47.86 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $79.43 / $208.93
| Facility | | $56.23 | $79.43 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $81.28 / $134.90
| Professional | | $53.70 | $81.28 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $45.71 / $66.07
| Professional | 26 | $32.36 | $45.71 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $32.36 / $64.57
| Professional | TC | $21.38 | $32.36 | $64.57 |