- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $173.78 / $501.19
| Facility | | $48.98 | $173.78 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $8.71 / $10.00
| Facility | 26 | $7.24 | $8.71 | $10.00 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $107.15 / $398.11
| Facility | TC | $21.38 | $107.15 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $38.02 / $112.20
| Professional | | $21.88 | $38.02 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $11.48 / $30.20
| Professional | 26 | $7.76 | $11.48 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $26.92 / $56.23
| Professional | TC | $15.85 | $26.92 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $26.92 / $31.62
| Professional | | $8.71 | $26.92 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $8.91 / $10.00
| Professional | 26 | $7.94 | $8.91 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $20.42 / $24.55
| Professional | TC | $19.05 | $20.42 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $35.48 / $43.65
| Facility | | $35.48 | $35.48 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $13.49 / $13.49
| Facility | 26 | $13.49 | $13.49 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $30.20
| Facility | TC | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $32.36 / $60.26
| Professional | | $22.39 | $32.36 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.31 / $9.77 / $18.62
| Professional | 26 | $6.31 | $9.77 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.49 / $22.91 / $41.69
| Professional | TC | $15.49 | $22.91 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $33.11 / $44.67
| Professional | | $29.51 | $33.11 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $9.55 / $13.18
| Professional | 26 | $8.51 | $9.55 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $23.44 / $32.36
| Professional | TC | $19.95 | $23.44 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $16.98 / $30.20
| Facility | | $6.46 | $16.98 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $30.90 / $63.10
| Professional | | $22.91 | $30.90 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.61 / $10.00 / $20.42
| Professional | 26 | $6.61 | $10.00 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.49 / $20.89 / $44.67
| Professional | TC | $15.49 | $20.89 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $32.36 / $45.71
| Professional | | $25.12 | $32.36 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $9.12 / $12.88
| Professional | 26 | $7.41 | $9.12 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $23.44 / $33.11
| Professional | TC | $18.20 | $23.44 | $33.11 |