- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $85.11 / $446.68
| Facility | | $9.33 | $85.11 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $112.20
| Facility | TC | $95.50 | $95.50 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $83.18 / $204.17
| Professional | | $44.67 | $83.18 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $36.31 / $120.23
| Professional | 26 | $10.00 | $36.31 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $69.18 / $123.03
| Professional | TC | $38.90 | $69.18 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $79.43
| Professional | | $37.15 | $37.15 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.75 / $11.48 / $15.49
| Professional | 26 | $5.75 | $11.48 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $30.90
| Professional | TC | $30.90 | $30.90 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $131.83 / $134.90
| Professional | | $104.71 | $131.83 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $18.62 / $25.12
| Professional | 26 | $18.62 | $18.62 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $112.20 / $112.20 / $151.36
| Professional | TC | $112.20 | $112.20 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $72.44 / $194.98
| Facility | | $10.96 | $72.44 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $77.62 / $162.18
| Professional | | $12.59 | $77.62 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $41.69 / $134.90
| Professional | | $30.90 | $41.69 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.37 / $7.08 / $48.98
| Professional | 26 | $5.37 | $7.08 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $33.11 / $95.50
| Professional | TC | $20.42 | $33.11 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $85.11 / $446.68
| Facility | | $9.33 | $85.11 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $112.20 / $112.20 / $112.20
| Facility | TC | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $87.10 / $194.98
| Professional | | $43.65 | $87.10 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $19.50 / $91.20
| Professional | 26 | $10.47 | $19.50 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $75.86 / $134.90
| Professional | TC | $52.48 | $75.86 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $38.90 / $112.20
| Professional | | $30.90 | $38.90 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.37 / $6.46 / $17.78
| Professional | 26 | $5.37 | $6.46 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $31.62 / $87.10
| Professional | TC | $20.42 | $31.62 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $70.79 / $147.91
| Professional | | $44.67 | $70.79 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $12.59 / $79.43
| Professional | 26 | $7.41 | $12.59 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $53.70 / $83.18
| Professional | TC | $37.15 | $53.70 | $83.18 |