- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $63.10 / $75.86
| Facility | | $52.48 | $63.10 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $33.11
| Facility | 26 | $30.90 | $30.90 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $75.86 / $199.53
| Professional | | $42.66 | $75.86 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $31.62 / $77.62
| Professional | 26 | $25.70 | $31.62 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $190.55
| Professional | 50 | $147.91 | $147.91 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $28.84 / $67.61
| Professional | TC | $15.14 | $28.84 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $109.65 / $120.23
| Professional | | $81.28 | $109.65 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $69.18 / $75.86
| Professional | 26 | $51.29 | $69.18 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $39.81 / $44.67
| Professional | TC | $30.20 | $39.81 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $93.33 / $147.91
| Professional | | $56.23 | $93.33 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $56.23 / $81.28
| Professional | 26 | $30.90 | $56.23 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $39.81 / $81.28
| Professional | TC | $21.38 | $39.81 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $83.18 / $173.78
| Facility | | $63.10 | $83.18 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $144.54 / $457.09
| Professional | | $63.10 | $144.54 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $57.54 / $190.55
| Professional | 26 | $31.62 | $57.54 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $89.13 / $316.23
| Professional | TC | $31.62 | $89.13 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $269.15 / $269.15
| Facility | | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $109.65 / $165.96
| Professional | | $58.88 | $109.65 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $47.86 / $77.62
| Professional | 26 | $26.92 | $47.86 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $60.26 / $107.15
| Professional | TC | $28.84 | $60.26 | $107.15 |