- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $213.80 / $549.54
| Facility | | $85.11 | $213.80 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $46.77 / $74.13
| Facility | 26 | $33.88 | $46.77 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $89.13 / $190.55
| Professional | | $41.69 | $89.13 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $52.48 / $107.15
| Professional | 26 | $28.18 | $52.48 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $52.48 / $107.15 / $275.42
| Professional | 50 | $52.48 | $107.15 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $57.54 / $91.20
| Professional | TC | $41.69 | $57.54 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $61.66 / $141.25
| Professional | | $56.23 | $61.66 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $31.62 / $38.02
| Professional | 26 | $23.99 | $31.62 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $93.33 / $109.65 / $199.53
| Professional | 50 | $93.33 | $109.65 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $38.90 / $61.66
| Professional | TC | $33.88 | $38.90 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $104.71 / $109.65
| Facility | | $48.98 | $104.71 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $120.23 / $120.23
| Professional | | $120.23 | $120.23 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $112.20 / $194.98
| Facility | | $97.72 | $112.20 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $93.33 / $165.96
| Professional | | $67.61 | $93.33 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $38.90 / $64.57
| Professional | 26 | $27.54 | $38.90 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $63.10 / $102.33
| Professional | TC | $43.65 | $63.10 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $107.15 / $239.88
| Facility | | $83.18 | $107.15 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $147.91
| Facility | 26 | $75.86 | $75.86 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $107.15 / $549.54
| Professional | | $87.10 | $107.15 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $42.66 / $204.17
| Professional | 26 | $33.88 | $42.66 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $64.57 / $338.84
| Professional | TC | $52.48 | $64.57 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $69.18 / $173.78
| Facility | | $63.10 | $69.18 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $97.72 / $158.49
| Professional | | $87.10 | $97.72 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $38.02 / $63.10
| Professional | 26 | $33.88 | $38.02 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $60.26 / $95.50
| Professional | TC | $52.48 | $60.26 | $95.50 |